Effective Learning Program for Healthcare Practitioners: Addressing the Challenges of Opioid Treatment at SAMC

Introduction

Today, there is an increased need for an effective learning program for healthcare practitioners, as well as other support staff (Gaspard & Yang, 2016). The significant focus becomes clear towards developing a comprehensive learning platform across the clinical or hospital setting. For St. Anthony Medical Center (SAMC), the issue of opioid treatment presents a key challenge for the organization in terms of addressing the cases that arise in the clinical setting. There is a demand for management to look into the scope of implementation of educational technology at the Center (Gaspard & Yang, 2016). The needs assessment plan provides findings from key participants within the hospital and evaluates the results to recommend best practices for the educational technology use in response to the opioid crisis.

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Methods

The needs assessment uses an interview approach to gather the necessary data on prevailing issues at the hospital (Greenberg, 2019). Four respondents apply from various departments, including the ER, orthopedics, behavioral health, and case management. These include Dr. Connolly, Dr. Cartwright, Dr. Zuckerman, and Vicki Vasquez respectively. The interview provides the administration with the capacity to dig deeper into the education technology use, exploring the context to gain more insight regarding the staff needs, concerns, potential barriers and existing opportunities (Greenberg, 2019).

Findings and Discussion

The needs assessment findings presented below represent data from the four interviews.

Training Needs

Across the various departments at SAMC, there is limited training on educational technology use. The comments from respondents are consistent with this finding:

"The beginning is when these drugs get prescribed in the first place. Have doctors across the hospital gotten training in best practices for opioid prescription? I'm going to guess no."

"In the orthopedics department, I've made sure that every doc has a copy of the latest prescribing guidelines for opioids. But what are they doing in the surgical departments, like Med/Surg or the bariatric unit?"

"If I were in charge, I'd make sure that learning content about prescribing guidelines got pushed proactively to every doctor with a prescription pad in this hospital."

"I know that doctors here are occasionally required or encouraged to get continuing education. But does the same thing happen with visiting doctors? Is anyone tracking what education they have or prompting them with updated content?"

"...if doctors prescribe NA only; I want my case managers to be educated in other options, in case patients say that they don't want to do a twelve-step program."

From the above comments, several problems arise. The process of opioid prescription at the hospital fails to utilize proper approaches towards assisting patients to a greater extent (Gaspard & Yang, 2016). For instance, there are different occasions where patients of opioid addiction come back to get treatment from the same place that gave them a prescription. Some of the patients have visiting privileges, which makes the SAMC less useful in administering the right process of treatment. Further, there is a limited focus on continuing education for doctors at the hospital (Dickerson, 2014; Lin et al., 2005)). With a severe crisis, such as opioid addiction, few doctors have the necessary knowledge to address the evolving opioid menace. Additionally, the Alternative Medicine unit has been trying to promote content on pain management with non-opioid options, which has gone unrecognized at SAMC.

Coordination of Procedures

From the findings, there is poor coordination of activities across various departments about the treatment of opioid addiction and withdrawal cases (Dickerson, 2014). The comments below from respondents portray this finding:

"Some of the doctors keep referring patients to NA only, and that's not good practice. There's Smart Recovery, there are methadone clinics, and there are addiction specialists."

"Does the hospital know what its doctors are prescribing?"

"We've done the right things publicly, but we need to coordinate our response better across the hospital."

Treatment Guidelines

Lastly, the findings suggest that CDS and LMS pose conflicting guidelines on the treatment of opioid cases (Lin et al., 2005). Given the view, such contradiction makes the practice challenging in terms of applying the right procedures.

Recommendations

Training

A key focus of SAMC rests with the exercise of medical practitioners, nurses and other support staff that directly interact with the patients. Resultantly, there is enhanced skills and capabilities in responding to opioid cases across the Center (Gaspard & Yang, 2016). A complete learning program is necessary across the board on basic treatment guidelines for opioid addiction and withdrawal symptoms. For doctors, the training needs to extend to new approaches in response to the opioid crisis. Moreover, the educational technology program must look into the continued education of the doctors to manage the problem early and with better strategies. Other departments that are indirectly related to the opioid treatment procedures require support training to foster preventive care and other non-treatment procedures for opioid addiction patients.

Definition of Objectives

The educational technology program needs to understand the areas to improve upon and assist in deciding which prescribing guideline leads to the pursuance of needs and goals. Following the evaluation of the current approach, and determining areas for improvement, the Center should define specific goals that the education technology use strives to achieve. With the change team, the Center can determine the objectives through gathering input from key stakeholders, including nurses, clinicians, and management. Some goals would include:

• Creating policies on opioid prescription and review within six months
• Providing at least three clinicians to become approved for buprenorphine application within six months.
• Reducing the number of patients prescribed with opioids and benzodiazepines by 12% within four months.

Universal Precautions

The application of universal procedures remains effective to offer a common approach across the various departments at SAMC. In prescribing opioids, universal precautions can refer to the isolation of patients requiring opioids from the other patients, and the treatment of each patient with different needs of opioids. Further, such procedures mean the hospital's identification of the causal factors for the pain syndrome, along with risks and opportunities for a prescription.

Leadership Support

The leadership at SAMC needs to offer great support to pursue a change in the treatment practice. To obtain such support, the Center must identify critical motivations for the change process, including aligning efforts with the goals and mission of the opioid treatment practice, showing the impact of opioid prescribing on employee satisfaction, and defining the financial metrics. Throughout the implementation, leadership should be kept engaged and informed. Further, leadership needs to provide the necessary resources, as well as give key change agents sufficient time to implement the changes.

Risk Assessment

Given opioid treatment and withdrawal guidelines, the Center needs to use their treatment agreements to address the problem of having patients return for a regular prescription. This seeks to minimize the risk of taking opioids in the long term. Such contracts must facilitate positive dialogue between key stakeholders. Further, there is a need to make sure that patients understand aspects of the treatment agreement and the necessary items for continued medication. For a tapering plan, the Center should collaborate with the patients. Finally, establishing a first documentation process in the agreement remains crucial for risk management.

References

Dickerson, P. (2014). Needs Assessment: Collecting the Evidence. Journal of Continuing Education in Nursing, 45(3), 104-105.

Gaspard, J., & Yang, C. M. (2016). Training needs assessment of health care professionals in a developing country: the example of Saint Lucia. BMC medical education, 16, 112. doi:10.1186/s12909-016-0638-9

Greenberg, C. I. (2019). How to Conduct a Training Needs Analysis. Retrieved from https://www.xperthr.com/how-to/how-to-conduct-a-training-needs-analysis/6716/

Lin, K., Chang, L.T., Tsai, F. & Kao, C. (2005). Examining the gaps between teaching and learning in the technology curriculum within Taiwan's 9-year articulated curriculum reform from the perspective of curriculum implementation. International Journal of Technology and Design Education, 25(3),363-385.