206008 Trauma patients on methadone maintenance: Designing processes of care to decrease interruptions in treatment during inpatient medical admissions

Tuesday, November 10, 2009: 9:42 AM

Heather A. Klusaritz, MSW , School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA
Rachel Boris, MSW, LCSW , Department of Social Work, Hospital of the University of Pennsylvania, Philadelphia, PA
Background: Interruptions in methadone maintenance treatment as a result of a medical hospital admission represent a significant barrier to timely discharge and reentry into treatment programs. Methadone use increases opiate tolerance and complicates achieving pain control following traumatic injuries. Methadone maintenance programs often deny reentry for patients using other substances including prescribed opiates. Trauma patients have high rates of drug abuse comorbidities and identification of methadone maintenance is critical to effective pain control and thus decreasing length of stay (LOS).

Methods: This retrospective cohort study, examined the medical records of all patients admitted to the trauma service from July 1, 2008 to November 1, 2008 with an identified need of methadone maintenance treatment. LOS, verification of methadone treatment and dose documentation, and date of inpatient methadone administration were analyzed.

Results: Of the 586 patients admitted during the study period, only 6 patients had clear documentation of methadone maintenance treatment. No cases had confirmation of methadone treatment and dose upon admission. There was no temporal consistency between verification of methadone dose and when methadone was first administered. Reentry into treatment was complicated for half of the cases. No clear relationship between dose verification, dose administration and LOS was found.

Implications: The lack of documentation and clear processes of care for these patients highlights the need for a protocol for to identify methadone maintenance treatment upon admission, verification of dose, and restart administration of dose. A quality initiative protocol to facilitate continuity of care for trauma patients on methadone maintenance was developed.

Learning Objectives:
1.Identify which hospital processes of care interrupt methadone maintenance treatment. 2.Articulate the procedure for confirming community-based methadone maintenance treatment. 3.Articulate the procedure for resuming methadone treatment for patients during a hospital admission. 4.Design a program to decrease interruptions in methadone maintenance for hospitalized patients

Keywords: Methadone Maintenance, Substance Abuse Treatment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and carried out this quality initiative with my co-author. I am a trauma social worker at the Hospital of the University of Pennsylvania. I am a doctoral candidate and adjunct instructor at the School of Social Policy & Practice at the University of Pennsylvania and teach a course on Health Care Social Work
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.