Integrating Hospital-Based Harm Reduction Care-Harnessing the Nursing Model

Area of Science:

• Public Health
• Nursing
• Addiction Medicine

Background:

• Hospitals pose risks for people who use drugs, often lacking substance use disorder (SUD) care and harm reduction (HR) interventions.
• Hospital hierarchies and staff stigma can impede the adoption of HR practices.
• Nurses are well-positioned to champion and deliver HR care within hospital settings.

Purpose of the Study:

• To describe the development and early implementation of a registered nurse (RN)-led HR intervention in a US hospital.
• To integrate HR philosophy and practices into traditional hospital structures.
• To assess the feasibility and initial reception of a nurse-led HR program.

Main Methods:

• Utilized the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework for model development.
• Secured pilot funding from Medicaid payers for RN salary and HR supplies.
• Engaged hospital leadership, nurse champions, legal counsel, and conducted staff-wide media campaigns and training.
• Collaborated with experts to develop bedside HR education and staff training modules.

Main Results:

• The RN-led HR intervention was implemented from September 2022 to March 2023.
• 459 staff members were trained across over 15 sessions.
• 209 patient encounters were conducted, with generally positive reception from patients and staff.
• Distribution of safe-use supplies, initially controversial, was embraced.

Conclusions:

• A nurse-led, hospital-based HR intervention is feasible and can expand patient services.
• This model supports hospital staff and effectively bridges harm reduction and medical care models.
• Early experiences indicate successful integration and acceptance of HR interventions within a hospital setting.