Harm-reduction Model in Er Nursing With Sa Patients- Literature Review

• Journal List
• BMJ Open
• v.11(10); 2021
• PMC8557290

BMJ Open up. 2021; 11(ten): e055654.

Protocol

Identifying damage reduction strategies for alcohol and drug-employ in inpatient intendance settings and emergency departments: a scoping review protocol

, ^{ane, 2} Mari Somerville,^one Leah Boulos,³ Alexander Caudarella,⁴ Daniel Crowther,¹ Catie Johnson,² Lori Wozney,^five Shannon MacPhee,² Douglas Sinclair,² Annette Elliott Rose,^two Caroline Jose,ⁱⁱⁱ and Morgan Joudrey²

Janet A Curran

^aneSchoolhouse of Nursing, Dalhousie Academy, Halifax, Nova Scotia, Canada

²Quality and Patient Condom, IWK Health Centre, Halifax, Nova Scotia, Canada

Mari Somerville

¹School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada

Leah Boulos

³Maritime SPOR Support Unit, Halifax, Nova Scotia, Canada

Alexander Caudarella

^fourMental Health and Addictions Service, St Michael's Hospital, Toronto, Ontario, Canada

Daniel Crowther

^oneSchool of Nursing, Dalhousie Academy, Halifax, Nova Scotia, Canada

Catie Johnson

ⁱⁱQuality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada

Lori Wozney

^fiveMental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada

Shannon MacPhee

²Quality and Patient Safety, IWK Wellness Heart, Halifax, Nova Scotia, Canada

Douglas Sinclair

²Quality and Patient Rubber, IWK Health Centre, Halifax, Nova Scotia, Canada

Annette Elliott Rose

ⁱⁱQuality and Patient Safety, IWK Wellness Middle, Halifax, Nova Scotia, Canada

Caroline Jose

^threeMaritime SPOR Support Unit of measurement, Halifax, Nova Scotia, Canada

Morgan Joudrey

²Quality and Patient Safety, IWK Health Eye, Halifax, Nova Scotia, Canada

Received 2021 Jul xix; Accepted 2021 Sep 28.

Supplementary Materials

Reviewer comments

GUID: 94C183ED-ACE6-4F8D-A28B-3C5EC8A9D4CE

Author's manuscript

GUID: 764B8B69-A550-4861-BB23-E4F6B88AA698

Abstract

Introduction

People who utilize alcohol and/or drugs (PWUAD) are at high take a chance of medical complications, frequent hospitalisation and drug-related death following discharge from inpatient settings and emergency departments (EDs). Harm reduction strategies implemented in these settings may mitigate negative wellness outcomes for PWUAD. Still, the scope of harm reduction strategies used globally within inpatient settings and EDs is unknown. The objective of this review is to identify and synthesise reported damage reduction strategies that accept been implemented across inpatient settings and EDs for PWUAD.

Methods and analysis

This review will include studies from whatsoever country and health service reporting on harm reduction strategies implemented in inpatient settings or EDs. The population of interest includes people of any race, gender and age identifying equally PWUAD, or individuals who provided care to PWUAD. Studies which describe implementation strategies and barriers and enablers to implementation will exist included. Studies published in English, or those available for English translation volition be included. The post-obit databases will exist searched: MEDLINE All (Ovid), Embase (Elsevier Embase.com), CINAHL with Total Text (EBSCOhost), PsycINFO (EBSCOhost) and SCOPUS (Elsevier Scopus.com). A grayness literature search will exist conducted. At that place will be no date restrictions on the search. Titles, abstracts and full texts will be screened in duplicate. Information will be extracted using a standardised form. The results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews.

Ethics and dissemination

Scoping reviews do not require ethical approving. Patient partners with lived feel and relevant knowledge users will be engaged as inquiry team members throughout all phases of the research procedure. A report detailing context, methodology and findings from this review volition be disseminated to knowledge users and relevant community stakeholders. This review will be submitted for publication to a relevant peer-reviewed journal.

Keywords: public health, substance misuse, social medicine, preventive medicine

Strengths and limitations of this study

• To the best of our knowledge, this scoping review will be the start of its kind to describe the range of damage reduction strategies for people who employ alcohol and/or drugs that have been implemented in inpatient and emergency department settings.

• This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and will take an integrated knowledge translation arroyo by engaging key knowledge users and patient partners throughout the inquiry process.

• Our search volition be express to 5 databases (MEDLINE All (Ovid), Embase (Elsevier Embase.com), CINAHL with Full Text (EBSCOhost), PsycINFO (EBSCOhost) and SCOPUS (Elsevier Scopus.com)) and searches for unpublished studies and grey literature will be retrieved and included following the systematic approach to grey literature searching outlined by Godin et al.

• Given that this is a scoping review, it volition non contain a meta-analysis of available evidence and will only depict how research in this field is being conducted, the types of evidence that are being produced and specific knowledge gaps within the literature.

• Our search will exist express to English language literature and non-English literature that is available for translation.

Introduction

Alcohol and drug utilise is associated with significant negative health outcomes. People who use booze and/or drugs (PWUAD) have a higher run a risk of infectious disease, drug-related complications and are more likely to be oft hospitalised when compared with other individuals.^{1 2} When seeking intendance, PWUAD are oftentimes discharged confronting medical advice or expelled equally a result of illicit drug use, leading to increased readmission rates and poorer hospital outcomes.² Encountering stigma or having negative experiences in hospital settings can prevent PWUAD from seeking medical help.^three Furthermore, PWUAD have a high run a risk of drug-related expiry subsequently being discharged from hospital.⁴ Therefore, PWUAD face health-related risks before, during and later receiving medical care, highlighting an urgent need to ameliorate healthcare.

Harm reduction is a pragmatic approach geared towards addressing firsthand needs across a wide range of wellness issues. Harm reduction aims to ameliorate the health, prophylactic and well-being of both the individual and the customs.^{5 six} Within the context of drug and booze utilise, harm reduction strategies provide alternatives to drug and booze forbearance for individuals who cannot or do not desire to stop using.^7–nine The Canadian Drugs and Substances Strategy has identified harm reduction every bit an integral part of their strategy to help accost some of the burden associated with substance apply.⁹ Some of the almost common damage reduction strategies used in the context of illegal substances include clean needle distribution, supervised drug intake, substitution therapy, rubber supply and the use of substances like naloxone to temporarily reverse the effects of opioid overdose.^7–eleven These strategies aim to improve well-being, lower rates of illness, overdose and decease because of substance use.^{half-dozen–9} Harm reduction in relation to substance use has been implemented in community-based,¹² home-based¹³ and inpatient settings.¹⁴ However, there is a demand to further understand the range of these harm reduction strategies.

In inpatient settings and emergency departments (EDs), there is some indication that harm reduction strategies could help to ameliorate health outcomes for PWUAD.^15–17 The use of these strategies within inpatient settings and EDs, remains low, despite high numbers of patients hospitalised with substance-induced symptoms¹⁸ and calls for damage reduction implementation in infirmary settings.^nineteen Depression uptake of harm reduction strategies has been attributed to inadequate staffing, lack of funding and stigma surrounding substance use.²⁰ Yet, to the best of our knowledge, the full range of available implementation strategies used in implementing harm reduction strategies and the range of barriers and enablers to implementation has not been fairly described.

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted and no current or underway systematic or scoping reviews on this topic were identified. Therefore, this study aims to identify and synthesise the literature on harm reduction strategies that have been implemented in inpatient settings and EDs among people who use substances.

Review questions

The post-obit questions will guide this review:

1. What impairment reduction strategies have been evaluated to help convalesce negative health outcomes associated with substance use inside inpatient settings and EDs?

2. How are harm reduction strategies implemented in inpatient settings and EDs?

3. What are the reported barriers and enablers to their implementation?

4. What are the commonly reported effect measures used to evaluate damage reduction strategies and their implementation in these settings?

Methods and analysis

The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews.²¹ This scoping review will utilize an integrated knowledge translation approach, working with health system determination makers and patient partners with lived experience through all stages of the review.²² This scoping review has been registered with The Open Science Framework (OSF) registries (Registration DOI: 10.17605/OSF.IO/P7BHN).

Inclusion criteria

Participants

This review will consider studies that include participants identifying as individuals with drug dependence or PWUAD who take been admitted to inpatient care or have accessed EDs for substance utilize related issues and/or any other medical issues. This review will besides consider individuals who provide intendance for persons with drug dependence or PWUAD. People of any race, gender and age will exist included.

Concept

This review will consider studies that investigate whatsoever intervention or implementation strategy of an intervention designed to reduce harm related to negative health outcomes associated with alcohol and/or drug utilise. Descriptions of implementation strategies may include whatsoever barriers and/or enablers to facilitating harm reduction strategies. This review will consider reported outcome measures, and not outcome data. These will include patient reported outcome measures (eg, quality of life), and patient reported experience measures (eg, feeling heard, receiving care asked for), likewise as health outcome measures (eg, length of stay, healthcare costs, recovery time, belch against medical advice, readmission rates, overdose rates and mortality).

Context

Any healthcare setting that provides inpatient intendance or has an ED, in any country will be considered. This may include hospital settings, community inpatient day facilities or rehabilitation facilities where individuals receive handling overnight. Outpatient settings and customs-based service settings will exist excluded.

Types of sources

This scoping review will include both experimental and quasi-experimental study designs including randomised controlled trials, non-randomised controlled trials, pre–post studies and interrupted fourth dimension-serial studies. In addition, observational studies including prospective and retrospective cohort studies, example–control studies, cross-sectional studies, case serial and individual case reports will exist considered for inclusion. Qualitative and mixed-methods studies volition also exist considered for inclusion. Grey literature sources such as policy documents and organisational reports will be included. To the best of our knowledge, bear witness syntheses which address our enquiry questions practice not exist and so cannot be included in this review. Nonetheless, the reference lists of any evidence syntheses identified by our search will be reviewed for relevant articles. Text and opinion papers will be excluded.

Search strategy

In collaboration with a JBI-trained information specialist, a search strategy will be developed to locate published manufactures in peer-reviewed journals and grey literature repositories. An initial limited search of MEDLINE All (Ovid) was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to draw the articles were used to develop a full search strategy for MEDLINE (online supplemental table 1). The MEDLINE search strategy was peer-reviewed by an information specialist earlier being translated to Embase (Elsevier Embase.com), CINAHL with Full Text (EBSCOhost), PsycINFO (EBSCOhost) and Scopus (Elsevier Scopus.com) (online supplemental table one). The reference lists of articles selected for total-text review will be screened for boosted papers. Manufactures published in English, or those available for English language translation volition be included. No limits will be placed on date of publication.

Information sources

The databases to be searched include MEDLINE All (Ovid), Embase (Elsevier Embase.com), CINAHL with Full Text (EBSCOhost), PsycINFO (EBSCOhost) and SCOPUS (Elsevier Scopus.com). Grey literature sources will be retrieved and included, post-obit the systematic arroyo to grey literature searching outlined by Godin et al.²³ We volition not search pre-print servers, as this is non a chop-chop emerging topic. However, pre-prints volition be screened and considered for inclusion. This topic is not appropriate for clinical trial research; therefore, we will not search trial registries.

Study/Source of evidence selection

Following the search, all identified records will be collated and uploaded into Covidence systematic review software (Veritas Wellness Innovation, Melbourne, Australia) and duplicates removed. Following a airplane pilot test, titles and abstracts volition be screened by 2 independent reviewers for assessment confronting the inclusion criteria. Potentially relevant papers will exist retrieved, and full texts volition be assessed against the inclusion criteria by two independent reviewers. Reasons for exclusion of total-text papers volition be recorded. Any disagreements that ascend between reviewers at each stage of the screening procedure will be resolved through discussion or with an additional reviewer/s. The results of the search will be reported and presented post-obit the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews.²⁴

Data extraction

Information will exist extracted from papers that meet inclusion criteria by two independent reviewers using a standardised data extraction tool (online supplemental table 2). The extracted data will include characteristics of study participants, setting, study blueprint and research objective. Damage reduction strategies employed by each written report, barriers and enablers to implementation and patient and health outcome measures will exist extracted.

The information extraction tool volition be modified and revised as necessary during the procedure of extracting data from each included paper. Modifications will exist detailed in the final scoping review. Authors of papers will be contacted to request missing or additional data, where required. Although scoping review methodology does non require critical appraisement of studies, on request from the cognition user, it was decided that included published peer-reviewed papers and guidelines volition be appraised using the Mixed Methods Appraisal Tool.²⁵

Information assay and presentation

Extracted data will be synthesised and reported in tables throughout the written report. A summary of each paper, including setting, publication date and country will exist presented to provide context for the research findings. Outcome measures will be reported separately and will be categorised based on harm reduction strategy and barriers and enablers to implementation.

The planned timeline for this review is to complete the title and abstruse screening by terminate of September 2021, have full-text screening completed by mid-October 2021, have information extraction completed past end of October, have a report finalised for submission to the knowledge user past mid-November 2021, and a manuscript finalised and submitted for publication by terminate of November 2021.

Patient and public involvement

Two patient partners were consulted during the development of the research questions and inclusion/exclusion criteria and provided feedback of the protocol manuscript. Both patient partners will be engaged to coproduce cardinal letters during the results stage and assist in the product of a plain language summary, which will exist distributed to local community organisations.

Ethics and dissemination

Given that this scoping review involves collecting and analysing previously published literature and does not involve research on humans or animals, we did not seek ideals approving from a inquiry ethics board. Withal, during the initial development of the research question and search strategy, all authors completed an equity, variety and inclusion reflection activity to identify and reverberate on individual bias and position in the literature. It was determined that individuals with lived experience of the topic area would be involved throughout the entire study procedure, from conceptualization to dissemination.

Results of this scoping review volition be disseminated to knowledge users and relevant community stakeholders through an initial written report. This document volition provide a detailed reporting of context, methodology, findings as well equally a lay summary, developed in partnership with our patient partners. Additionally, this review will be submitted equally a manuscript for publication to a relevant scientific journal.

Supplementary Material

Acknowledgments

We would like to thank our patient partners for their piece of work on this project. We would like to admit the Nova Scotia Health Dominance, IWK Health, St Michael's Hospital and the Strategy for Patient-Oriented Research Evidence Alliance for their support of this project.

Footnotes

Contributors: JAC, MS, LB and Ac conceptualised the study, designed the search strategy and contributed to writing the manuscript. DC and CJohn contributed to writing the manuscript. SM, LW, DS and AER supported the study conceptualisation and informed the search strategy. CJose and MJ provided a patient perspective during conceptualisation of the study and edited the manuscript.

Funding: This project is funded by the Strategy for Patient-Oriented Research Evidence Alliance in partnership with the Canadian Institutes of Health Research (Grant number: Q80-21).

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has non been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are non endorsed by BMJ. BMJ disclaims all liability and responsibility arising from whatsoever reliance placed on the content. Where the content includes any translated fabric, BMJ does not warrant the accurateness and reliability of the translations (including simply not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for whatsoever error and/or omissions arising from translation and adaptation or otherwise.

Ethics statements

Patient consent for publication

Not required.

References

ane. McNeil R, Kerr T, Pauly B, et al. . Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of impairment reduction interventions into hospitals. Addiction 2016;111:685–94. 10.1111/add.13214 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

two. Rachlis BS, Kerr T, Montaner JSG, et al. . Harm reduction in hospitals: is it time? Impairment Reduct J 2009;half-dozen:1–4. 10.1186/1477-7517-6-19 [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

iii. Carusone SC, Guta A, Robinson S. "Possibly if I terminate the drugs, then maybe they'd care?"—infirmary intendance experiences of people who use drugs. Harm Reduct J 2019;xvi:1–10. 10.1186/s12954-019-0285-vii [PMC free article] [PubMed] [CrossRef] [Google Scholar]

iv. White SR, Bird SM, Merrall ELC, et al. . Drugs-Related death soon afterwards hospital-discharge among drug treatment clients in Scotland: record linkage, validation, and investigation of risk-factors. PLoS One 2015;10:e0141073. 10.1371/journal.pone.0141073 [PMC costless article] [PubMed] [CrossRef] [Google Scholar]

6. Vearrier L. The value of harm reduction for injection drug employ: a clinical and public health ideals analysis. Dis Monday 2019;65:119–41. 10.1016/j.disamonth.2018.12.002 [PubMed] [CrossRef] [Google Scholar]

10. Platt 50, Minozzi Southward, Reed J, et al. . Needle and syringe programmes and opioid commutation therapy for preventing HCV transmission among people who inject drugs: findings from a cochrane review and meta-analysis. Habit 2018;113:545–63. 10.1111/add together.14012 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

11. Csete J, Elliott R. Consumer protection in drug policy: the human rights instance for safe supply as an element of harm reduction. Int J Drug Policy 2021;91:102976. 10.1016/j.drugpo.2020.102976 [PubMed] [CrossRef] [Google Scholar]

13. Courser MW, Raffle H. With crisis comes opportunity: unanticipated benefits resulting from pivots to accept-home naloxone (THN) programs during the COVID-19 pandemic. J Subst Abuse Treat 2021;122:108220. x.1016/j.jsat.2020.108220 [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

fourteen. Sharma G, Lamba W, Cauderella A, et al. . Harm reduction in hospitals. Harm Reduct J 2017;14:i–iv. 10.1186/s12954-017-0163-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15. Elphinston RA, Sterling M, Leung J, et al. . Brief psychological interventions for reducing prescription opioid use, related harm, and pain intensity in patients with chronic pain: a systematic review and assessment of patient interest. Clin J Pain 2021;37:270–lxxx. 10.1097/AJP.0000000000000908 [PubMed] [CrossRef] [Google Scholar]

16. Sharpe South, Kool B, Whittaker R, et al. . Event of a text bulletin intervention on alcohol-related harms and behaviours: secondary outcomes of a randomised controlled trial. BMC Res Notes 2019;12:267. 10.1186/s13104-019-4308-y [PMC free article] [PubMed] [CrossRef] [Google Scholar]

17. Saunders E, Metcalf SA, Walsh O, et al. . "Yous tin see those concentric rings going out": emergency personnel's experiences treating overdose and perspectives on policy-level responses to the opioid crisis in New Hampshire. Drug Alcohol Depend 2019;204:107555. x.1016/j.drugalcdep.2019.107555 [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

xviii. Calcaterra SL, Binswanger IA, Edelman EJ, et al. . The affect of access to addiction specialist on attitudes, behavior and infirmary-based opioid use disorder related intendance: a survey of hospitalist physicians. Subst Abus 2020;0:1–9. 10.1080/08897077.2020.1748169 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

20. Hobden KL, Cunningham JA. Barriers to the dissemination of 4 impairment reduction strategies: a survey of addiction treatment providers in Ontario. Damage Reduct J 2006;three:35–20. 10.1186/1477-7517-three-35 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

21. Aromataris E, Munn Z. JBI manual for evidence synthesis. JBI, 2020. [Google Scholar]

22. Government of Canada CI of Hr . Guide to cognition translation planning at CIHR: integrated and Cease-of-Grant approaches, 2012. Bachelor: https://cihr-irsc.gc.ca/e/45321.html [Accessed 07 Jul 2021].

23. Godin M, Stapleton J, Kirkpatrick SI, et al. . Applying systematic review search methods to the grayness literature: a case study examining guidelines for schoolhouse-based breakfast programs in Canada. Syst Rev 2015;4:138. 10.1186/s13643-015-0125-0 [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]

24. Tricco Ac, Lillie E, Zarin W, et al. . PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467–73. 10.7326/M18-0850 [PubMed] [CrossRef] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557290/

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