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Tweed Opioid Treatment Program

Project Added:
12 October 2015
Last updated:
26 October 2015

Tweed Opioid Treatment Program

Summary

This project gathered feedback from clients, clinicians and case workers to define a single set of criteria used to assess when clients are eligible to receive medication to take home and consume the next day (called a one-off takeaway). 

Aim

To create an objective assessment tool for one-off takeways, in partnership with clients and clinical staff in the Tweed Opioid Treatment Program (OTP).

Benefits

  • Enhances therapeutic relationship between the client and clinician.
  • Provides an objective assessment tool for one-off takeaway doses.
  • Empowers clients to participate in the management of their condition.
  • Improves collaboration between clinicians and case workers.
  • Reduces adverse outcomes from one-off takeaways with a standardised approach.

Project status

Dates

  • Client takeaway survey: December 2012
  • Tool developed: September 2013
  • Tool implemented: December 2013
  • Executive approval for use across NNSWLHD: June 2014

Status

Sustained - The project has been implemented, is sustained in standard business.

Background

Medications used in opioid treatment are usually dispensed to clients for immediate consumption on a daily basis, under supervision. When clients are given medication to take home and consume the next day, this is called a takeaway dose.

Historically, clinical guidelines required a ‘Suitability for Takeaway Doses Assessment Form’ to be completed for clients looking to get permanent takeaway doses. If a client wanted a one-off takeaway due to illness, a short trip or holiday such as Christmas Day, it was not suitable because the process was lengthy, time-consuming and highly risk-averse.

The accepted practice was for the prescribing doctor to make the decision according to their own assessment of the client. This created difficulties, as there was no transparency and equality across the system. For example, some doctors would allow a one-off takeaway despite occasional amphetamine use, while others would not.

The Tweed OTP is undergoing a culture change, to empower clients with more autonomy in the management of their condition. The quality of the therapeutic relationship is critical to this change and is enhanced when the delivery of care is a partnership. The rise of evidence-based practice and patient-centred care has focused on considering the client’s perspective and participation in service development. In drug and alcohol treatment, there has been a widely-held view that it is not the client’s place to participate and that they do not have the interest or skills to do so. This project challenged that view and was part of an on-going planned culture change at Tweed OTP.

Implementation 

  • Consultation with staff determined that an objective assessment tools for one-off takeaways would address most of the problems with the existing system.
  • Clients were asked to provide feedback on what the criteria of the one-off takeaway assessment tool should be, as well as what ‘stability’ meant to them.
  • Client feedback was gathered using large sheets of butcher’s paper hung in the dosing area of the clinic. A nurse helped clients write their comments and encouraged positive group discussion, to ensure active participation and overcome poor literacy skills that may be a barrier to participation.
  • Doctors were asked for their feedback on the minimum criteria for prescribing a one-off takeaway.
  • Case managers were asked to contribute their opinion on what demonstrated stability in clients.
  • Once all feedback was collated, a triangulation of the three sets of criteria was generated to assess similarities and obtain a consensus of what the criteria would be.
  • A draft tool including four areas for stability assessment, two from clients and two from clinicians, was devised and approved by area management.
  • In December 2013, clients were informed that the tool they helped develop would be used to assess all clients for a one-off takeaway for Christmas Day.
  • A client education board showed the new tool, photos of the butcher’s paper with their comments and how their perspectives were incorporated into the criteria for one-off takeaway assessments.

Client criterai for take-aways
Client perspective of criteria for takeaways

Implementation site

  • Tweed/Byron Drug and Alcohol Service, Tweed Hospital, Northern NSW Local Health District (NNSWLHD)

Results

  • 27 clients were assessed using the new one-off takeaway assessment tool and 17 were eligible for a takeaway on Christmas Day.
  • There were no complaints about unfairness and when clients were individually informed of the decision, some clients said that as they knew what the criteria was, they knew they wouldn’t be eligible and accepted the decision.
  • After Christmas Day, each client who had received a takeaway had a follow up confidential interview to discuss the process of creating the tool and how it impacted their family and friends. There were some common themes that emerged from the feedback:
    • clients felt trusted
    • it was a new process for clients
    • families felt reassured that they were doing the right thing, because the clinic had trusted them with a takeaway
    • some clients were worried about how they would handle it and were surprised to discover that they had moved on from drug use because they did the right thing.
    • participating in the development of the criteria helped clients understand why the assessment was required and reduced negativity to clinic rules.
  • The evaluation was positive and there were no adverse outcomes.
  • The one-off takeaway assessment tool is now used at the Tweed OTP for all one-off takeaways.
  • After the success of this project, the program now aims to incorporate client input on all processes that involve clients and all documentation provided to clients.
  • The one-off takeaway assessment tool is now approved for use in other clinics across NNSWLHD.

Lessons learnt

  • A major lesson for staff was accepting and using the clients own opinions and insights to develop solutions .Over time the level of staff  and client collaboration needed for this project has created a new respect between both parties.
  • The project can be easily implemented in other outpatient services treating chronic illness.

Resources

Further reading

  • Bryant J, Saxton M, Madden A et al. Consumers' and providers' perspectives about consumer participation in drug treatment services: Is there support to do more? What are the obstacles? Drug and Alcohol Review 2008; 27(2): 138-144.
  • Madden A, Lea T, Bath N et al. Satisfaction guaranteed? What clients on methadone and buprenorphine think about their treatment. Drug & Alcohol Review 2008; 27(6): 671-678. DOI: 10.1080/09595230801935706.
  • NSW Department of Health. A Guide to Consumer Participation in NSW Drug and Alcohol Services. Mental Health and Drug and Alcohol Office; 2005. Retrieved from www.health.nsw.gov.au.
  • NSW Department of Health. NSW Opioid Treatment Program: Clinical guidelines for methadone and buprenorphine treatment of opioid dependence. Mental Health Drug and Alcohol Office; 2006. Retrieved from www.health.nsw.gov.au.
  • Treloar C, Fraser S, Valentine K. Valuing methadone takeaway doses: The contribution of service-user perspectives to policy and practice. Drugs: Education, Prevention & Policy 2007; 14(1): 61-74. DOI: 10.1080/09687630600997527.
  • Van Hout MC, McElrath K. Service user involvement in drug treatment programmes: Barriers to implementation and potential benefits for client recovery. Drugs: Education, Prevention & Policy 2012; 19(6): 474-483. DOI: 10.3109/09687637.2012.671860.
  • Australian Commission on Safety and Quality in Health Care. Safety and Quality Improvement Guide Standard 2: Partnering with Consumers (October 2012). Sydney: ACSQHC; 2012.

Contact

Dawn Walton
Registered Nurse, Tweet Opioid Treatment Program
Tweed/Byron Drug and Alcohol Service, Tweed Hospital
Northern NSW Local Health District
Phone: 07 5506 7612
Dawn.Walton@ncahs.health.nsw.gov.au

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