Jennifer Jones, MSN, PMHNP, CARN-AP, Matthew Tierney, MS, PMHNP, FAAN, Sandra Mallisham, DNP, PMHNP, and Gabrielle Jacobs, MSW, MSN, PMHNP, San Francisco Veterans Affairs Health Care System, California, and University of California San Francisco School of Nursing. Shao-Yun Chien, BS, University of California San Francisco School of Nursing.
J Addict Nurs. 2020 Oct/Dec;31(4):261-268. doi: 10.1097/JAN.0000000000000366.
Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment.
Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training.
At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training.
This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness.
尽管退伍军人事务部（VA）努力通过提供治疗阿片类药物使用障碍（MOUD）的丁丙诺啡来扩大治疗范围，但仍有很少患有阿片类药物使用障碍的退伍军人接受有效治疗。从业人员不足导致丁丙诺啡的使用不足；然而，现在护士从业者（NPs）可以获得开这种药物的豁免。这个质量改进项目旨在通过向在退伍军人事务医疗保健系统的急诊环境中工作的精神病心理健康护士从业者（PMHNPs）提供关于免费 MOUD 培训的教育，并赋予他们使用丁丙诺啡治疗的能力，来扩大处方从业人员队伍。
询问了 11 名 PMHNPs 对开丁丙诺啡的看法。他们被问到是否有 MOUD 豁免，以及是否知道免费豁免培训。PMHNPs 接受了关于获得 DEA-X 豁免的重要性和程序的教育，然后进行了干预后的讨论，以确定他们是否完成了豁免培训。
在基线时，所有 11 名 PMHNPs 都认为提供 MOUD 很重要，但只有 3 人有开丁丙诺啡的豁免。在接受教育后，又有 3 名 PMHNPs 获得了豁免，10 名计划在明年获得豁免。该部门正计划试行提供丁丙诺啡治疗，而该设施的 PMHNPs 有特权开丁丙诺啡。此外，有 5 名新的 PMHNP 住院医生开始或完成了培训。
这个项目表明，通过强调教育和赋予 PMHNPs 启动治疗的能力，有可能增加退伍军人获得 MOUD 的机会。在急诊环境中强调丁丙诺啡治疗的重要性，并提供关于免费豁免培训的信息，促进了劳动力的准备。
