Background: Overdose-related deaths in adolescents have increased, making recognition and treatment of substance use (SU) an issue of critical importance. However, pediatricians are failing to screen and manage SU withdrawal among hospitalized adolescents. Driving factors include no standard process, addiction specialists’ discomfort in treating pediatrics, and discomfort in inpatient providers in managing addiction. Through this project, we hope to screen for problematic substance use, mitigate risk for withdrawal in hospitalized adolescents, and offer resources and treatment for those who need it. The objective is to increase the percentage of adolescent patients screened for substance use from 58% to 80% in 6 months.
Methods: Stakeholders were gathered, and a driver diagram was completed to address the underlying contributors for success. A validated screening process (CRAFFT 2.1+n) and brief interventions as recommended by the 2016 AAP Clinical Report were integrated into the existing psychosocial history on hospital admission. Opioid, alcohol, and benzodiazepine withdrawal protocols were created, and a SU risk assessment and treatment algorithm was implemented. Project measures included percent of patients with positive SU screen (outcome), screened with a validated tool (process), who received brief intervention (process), and percent of patients with a positive screen who received resources (process).
Results: A total of 219 pre-intervention encounters and 823 post-intervention encounters were reviewed. The percentage of adolescent hospital encounters who received SU screen increased from a median of 58% to 76%, with validated screens increasing from 0 to 64%. 17.5% of CRAFFT screens were positive, with 7% (n=24) medium risk and 11% (n=38) high risk. Brief interventions were performed for 94% (n=318) of patients who received a validated SU screen. All of the suggested types of brief interventions were completed at least once. Patients with a positive screen who received resources on discharge increased from a median of 0 to 42%.
Conclusions: We successfully increased SU screening but have not yet achieved our goal of 80%. Next steps include investigating the equity of our screening and management. We also hope to improve our naloxone prescribing practices, as there were many missed opportunities among high-risk patients.
