A Quality Improvement Pilot to Implement an Inpatient Opioid Withdrawal Screening Pathway

Using quality improvement (QI) methods, we sought to improve the inpatient screening of opioid withdrawal symptoms using the Clinical Opioid Withdrawal Scale (COWS), an industry validated instrument that is not widely used in the inpatient setting. By educating nurses and providers on the clinical manifestations of opioid withdrawal and implementing an evidence-based Opioid Withdrawal Screening Pathway, we sought to improve outcomes for those at risk for opioid withdrawal during hospitalization.

The pre-post test design using Plan-Do-Study-Act cycles involved two implementation phases. Phase I consisted of a 2-week formal education program for nurses and providers, including topics such as opioid use disorder, opioid withdrawal symptoms, COWS, opioid withdrawal treatment options, and criteria for consultation with the Inpatient Pain Management Team. Phase II involved a 12-week implementation of the Opioid Withdrawal Screening Pathway using COWS assessments and QI chart audits of pathway compliance data.

Screening of illicit drug use rates were low, yet significantly increased during the QI pilot. Education completion rates were high. Discharge against medical advice rates and average length of stay were significantly reduced. Transfers to a higher level of care did not involve illicit opioid use and were not significant for two units. The incidence of workplace violence events was equal between baseline and implementation data.

Through the implementation of an education program and screening pathway, the health care organization improved its screening rates of illicit opioid use and number of COWS assessments.