A116 PROMOTING ALCOHOL CESSATION IN THE INPATIENT GASTROENTEROLOGY WARD

TL;DR

This paper describes efforts to improve alcohol cessation care for patients in a gastroenterology ward by increasing the prescription of anti-craving medications.

Contribution

The study introduces a quality improvement initiative using education and EMR-based tools to address gaps in alcohol use disorder treatment during hospital stays.

Findings

Educational interventions temporarily increased anti-craving medication prescriptions but lacked sustainability.

A significant portion of gastroenterology staff were uncomfortable prescribing addiction medications.

An EMR-based order set is being developed to standardize alcohol use disorder screening and referrals.

Abstract

Alcohol use disorder (AUD) is a significant global health issue, ranking as the third leading cause of death and disability, with a financial burden exceeding $16 billion annually for the Canadian healthcare system. A recent review of patient discharges from the inpatient Gastroenterology ward at University Hospital revealed that less than 8% of patients with AUD were discharged with anti-craving medications or addiction referrals, highlighting a gap in care coordination

Increase the prescription rate of anti-craving medications by 20% for patients admitted with alcohol-related conditions to the Gastroenterology ward within the next 6 months, to improve post-discharge care and addiction support

The project began by identifying key stakeholders and surveying 22 residents rotating through gastroenterology and 11 consultant physicians. Results revealed that 34.7% of residents and 36.4% of consultants were uncomfortable prescribing medications for alcohol use disorder. Root cause analysis identified several issues: limited knowledge of anticraving medications, lack of addiction resources, time constraints, and no standardized process for identifying high-risk alcohol use disorder patients.

Multiple Plan-Do-Study-Act (PDSA) cycles were implemented, targeting trainee education with handouts, early detection of high-risk patients using the AUDIT-C questionnaire at admission, and increasing referrals to addiction services and social work

Between January and July 2024, a total of 57 patients with alcohol-related admissions were identified. During the intervention period, educational handouts for trainees and a Gastroenterology educational grand rounds presentation were implemented, demonstrating some success in increasing rates of anticraving medications. However, these results were not sustained, highlighting the need for a long-term solution. We are developing an EMR-based admission order set to standardize AUDIT-C completion, facilitating the identification of high-risk inpatients and automatic consultations with social work and addiction services through informatics principles

Although educational interventions temporarily increased rates of anticraving medications, the results were not sustainable. The project is ongoing and will transition to exploring EMR-based interventions

Comfort of Prescribing Anti-Craving Medication among GI staff

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