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. 2024 Feb 2:5:26334895231226193.
doi: 10.1177/26334895231226193. eCollection 2024 Jan-Dec.

Feasibility of implementing a screening tool for risk of opioid misuse in a trauma surgical population

Amelia Baltes  1 , David Horton  1 , Colleen Trevino  2 , Andrew Quanbeck  1 , Brienna Deyo  1 , Christopher Nicholas  1 , Randall Brown  1
Affiliations

Feasibility of implementing a screening tool for risk of opioid misuse in a trauma surgical population

Amelia Baltes et al. Implement Res Pract. .

Abstract

Background: As the opioid crisis continues to affect communities across the United States, new interventions for screening and prevention are needed to mitigate its impact. Mental health diagnoses have been identified as a risk factor for opioid misuse, and surgical populations and injury survivors are at high risk for prolonged opioid use and misuse. This study investigated the implementation of a novel opioid risk screening tool that incorporated putative risk factors from a recent study in four trauma units across Wisconsin.

Method: The screening tool was implemented across a 6-month period at four sites. Data was collected via monthly meeting notes and "Plan, Do, Study, Act" (PDSA) forms. Following implementation, focus groups reflected on the facilitators and barriers to implementation. Meeting notes, PDSA forms, and focus group data were analyzed using the consolidated framework for implementation research, followed by thematic analyses, to generate themes surrounding the facilitators and barriers to implementing an opioid misuse screener.

Results: Implementation facilitators included ensuring patient understanding of the screener, minimizing staff burden from screening, and educating staff to encourage engagement. Barriers included infrastructure limitations that prevented seamless administration of the screener within current workflows, overlap of the screener with existing measures, and lack of guidance surrounding treatment options corresponding to risk. Recommended solutions to address barriers include careful timing of screener administration, accommodating workflows, integration of the screening tool within the electronic health record, and evidence-based interventions guided by screener results.

Conclusion: Four trauma centers across Wisconsin successfully implemented a pilot opioid misuse screening tool. Trauma providers and unit staff members believe that this tool would be a beneficial addition to their repertoire if their recommendations were adopted. Future research should refine opioid misuse risk factors and ensure screening items are well-validated with psychometric research supporting treatment responses to screener-indicated risk categories.

Keywords: implementation outcomes; opioid; opioid misuse; opioid use disorder; pain management; preventive intervention; screening; surgery; trauma.

Plain language summary

As the opioid crisis continues to affect communities across the United States, new interventions for early screening and prevention are needed to minimize the related harms. Prior research has identified risk factors associated with opioid misuse among a trauma surgical patient population, with the highest risk associated with distress-related posttraumatic stress disorder symptoms. A pilot screening tool was created based on this prior research, which was then administered at four trauma surgical units across the state of Wisconsin. Each of the four trauma units successfully implemented the pilot screening tool, and each identified a number of facilitators and barriers to the implementation process. Recommendations for improvement of the implementation process were also gathered. If their recommended changes were to be adopted, trauma providers and trauma unit staff members believed that such a screener for opioid misuse would be a beneficial addition to their current workflow among traumatic injury patients. Future research should refine opioid misuse risk factors and develop a psychometrically sound, validated screener to detect varying levels of risk and tailor treatment approaches based on a patient’s risk score. Additionally, future research in the field of opioid misuse prevention should prioritize the recruitment of a more diverse population to support the translation of study findings across populations.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Quanbeck has a shareholder interest in CHESS Health, a public benefit corporation that disseminates a mobile phone intervention for patients and family members struggling with use disorders. Other co-authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Pilot Screening Tool Score Distribution Among Sites
Figure 2
Figure 2
Stakeholder Feedback of Perceived Barriers and Recommendations
See this image and copyright information in PMC

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