The Brigham Comprehensive Response and Education (B-CORE) Program is designed to serve the entire Brigham Health system to address all aspects of opioids as they relate to our patients and the communities we serve. The program’s initiatives include prescribing guidelines, improving access to naloxone to help reverse overdoses, improving access to treatment for patients with opioid use disorder, interfacing with Partners HealthCare system to expand resources for providers and focusing on educating providers and patients regarding the safe use of opioids. At Brigham and Women’s Faulkner Hospital, in their first year, a multidisciplinary B-CORE Committee chaired by Samata Sharma, MD, MPH, from Addiction Medicine/Consult Liaison Psychiatry, has begun focusing on these initiatives.
“We see patients struggling with opioid use disorder and other substance use disorders in our Emergency Department, in the inpatient detoxification unit on 6 North and in our inpatient and outpatient psychiatry departments,” says Dr. Sharma. “At BWFH, we are very fortunate to have clinicians with world class expertise and the consistent support of our hospital’s leadership, which allows us to both innovate and intervene at the various stages of the addiction process and help move the needle toward recovery.”
At its inception, the committee, which is made up of members from internal medicine, addiction medicine, psychiatry, pain management, the ED, orthopaedics, nursing, the pharmacy and social work, created a charter and set goals, including:
- Encouraging a more uniformed approach to both acute and chronic pain management with concrete treatment guidelines across inpatient and ambulatory settings
- Supporting non-opiate and non-pharmacologic treatment as first line non-cancer chronic pain management options
- Creating interdisciplinary care plans for the management of complex patients with opioid dependence and chronic pain needs and piloting a consult-based service by addiction psychiatry to interface with the patient and various providers in creating individualized care plans
- Leveraging addiction services at every opportunity to optimize patient care
- Generating and disseminating shared IT resources to facilitate communication and care delivery
“We are a small hospital, which allows us to implement change relatively quickly,” says Dr. Sharma. In fact, in just one year, the group achieved hospital-wide adoption of B-CORE’s prescribing guidelines for acute/chronic pain, advocated for wider use of the orthopaedic department’s multi-modal acute pain management algorithm, strived to increase immediate accessibility to nasal naloxone (as already implemented in the ED) and established an Addiction Psychiatry Consult Service to communicate between inpatient and outpatient services and allow for suboxone bridge prescriptions for patients who need a short-term prescription while they transition from inpatient to outpatient services. Finally, the group continues to raise awareness of the recent rapid expansion of the outpatient services offered by the Addiction Recovery Program, including a new Dual-Diagnosis Partial Hospital Program. “We now offer programs for every stage of the recovery process here at BWFH,” explains Dr. Sharma.
Next year, BWFH’s B-CORE Committee hopes to do even more by expanding access to nasal naloxone and offering more opportunities for providers and members of the community to be trained on its use. They also hope to develop a greater collaborative interface in both the inpatient and outpatient settings between internal medicine, surgery, the Addiction Recovery Program, primary care and pain management; expand the Addiction Psychiatry Consult Service to include outpatient and inpatient cases; increase awareness and utilization of current resources; start to develop a bridge clinic model to fill the gap in care for patients as they transition from inpatient to outpatient services and establish a non-narcotic, non-NSAID acute and chronic pain management algorithm.
“We have so much to offer here,” says Dr. Sharma. “My hope is that when referring physicians think of evidence-based compassionate care delivered in a non-judgmental manner for their patients, they first think of BWFH.”
