ID: HR19-1051

Presenting author: Emma Garrod

Presenting author biography:

Emma Garrod is a Clinical Nurse Educator and Masters Candidate at the University of BC. She has worked for over 10 years in HIV and substance use care, in community and hospital settings. Her interests include substance use education for nurses, harm reduction, drug policy, and peer inclusion.

Hospital harm reduction: peer and provider perspectives

Emma Garrod, Wendy Stevens, Melissa Nicholson, Elyse Magee, Scott Harrison

Issue:
Patients admitted to hospital may still actively use illicit substances and are often met with judgment and abstinence-based policies. Research has demonstrated that these patients frequently leave before receiving needed care, leading to antibiotic resistance and costly readmissions. Further studies examined patient and nurse experiences: people who use drugs (PWUD) describe hospitals as a risk environment where it is nearly impossible to have their needs met and nurses expressed ethical tensions between providing harm reduction interventions and abstinence-based hospital policy.

Setting:
St. Paul’s Hospital in Vancouver, Canada is an inner-city hospital serving a population with high rates of substance use. It sees the highest rates of opioid overdoses in the region and is a leader in hospital harm reduction initiatives.

Key Arguments:
Harm reduction is an evidence-based intervention with principles that can be applied in a hospital setting, and site-specific research with both patients and nurses indicated the need for policy revision. A group convened to change organizational policy, improving care for this population and clarifying approaches to substance use.

Outcomes and Implications:
Two policies were revised- “Alcohol and Substance Use-Inpatient Care” and “Philosophy of Care for Patients Who Use Substances.” With harm reduction written into corporate policy, care providers are able to have open conversations with patients and better meet their needs. Policy provided foundational support for many harm reduction initiatives, including an organization-wide take home naloxone program, managed alcohol program, injectable opioid agonist therapy and an overdose prevention site located at the hospital. Staff are supported with a Clinical Nurse Educator focused on substance use, a robust Addiction Medicine Consult Team and peers who can provide a lived-experience lens to patient care. The hospital has become a leader in harm reduction, sharing policies and practices widely. Perspectives on policy change from a peer lens will be shared.