Emergency Department Provider Toolkit | Avoid Opioid SD

Emergency Department Provider Toolkit

South Dakota Resource Hotline 1-800-920-4343

This toolkit supports Emergency Department Providers (ED) in preventing overdoses and improving care for patients at risk for opioid use disorder (OUD) and overdose.

OUD is a life-threatening disease. For every death due to opioid drug overdose in South Dakota, there were two hospital admissions for opioid overdoses and related disorders. Additionally, people who overdose are at a higher risk for future overdoses. The ED is an ideal setting to improve patient outcomes and support patients’ transitions into recovery.

The ED toolkit is an interactive guide for providers and hospital administrators. It provides strategies to incorporate best practices for screening and diagnosis, referral to treatment, safe prescribing, and community resources in an ED setting. Its content was developed for ED providers with considerations for rural and urban hospitals.

In South Dakota, opioid related deaths have increased since 2012. For more on opioid-related statistics please visit the key data page.

Decision Tree for Providers

1Screen & Identify Patient Risk
2Diagnose
3Treat
4Educate & Prescribe
Is the patient stable?

Patient is Stable

During your consultation:
  1. Review the patient’s history.
  2. Conduct a physical exam and pain assessment.
  3. Review PDMP. Then, identify MME/day or calculate MME/day.
  4. Ask if the patient has a primary care provider.
Based on findings from these steps, choose which path best fits the patient:
  1. Suspect OUD
  2. Common Acute Pain Condition

Unstable Overdose

If patient is unstable
  1. Follow standard procedures for stabilization of the patient
  2. Follow toxicology protocol—coming soon!
  3. Encourage screening, review of PDMP, diagnosis, and treatment once medically stable

Screening Complete! Start a New Screening

Suspect OUD

Determine if patient has OUD through use of one of the following screening tools:
  1. COWS
  2. SOAPP-R
  3. NIDA Quick Screen
Consider combining with patient self-assessment:

The COMM tool improves the ability to detect opioid misuse and further help to mitigate the potential of opioid exposure with patients and populations.

Continue to Diagnose

Common Acute Pain Condition

If common acute pain condition
  1. Use SDSMA Acute Pain Guidelines for non-opioid or non-pharmacological treatment of acute pain as first-line intervention. The guidelines summarize the current evidence for optimal management of acute pain and lists key recommendations.

Screening Complete! Start a New Screening

Diagnosing of OUD in the ED is necessary for treatment, intervention, and patient care:
  1. Follow the DSM-5 Diagnostic Criteria Checklist to determine the severity of OUD.
  2. Ensure that the appropriate opioid-related ICD-10 Codes are assigned for diagnosis.
Choose the patient’s diagnosis:
  1. If Diagnosed with OUD
  2. If NOT Diagnosed with OUD
Medication-Assisted Treatment (MAT) is among the leading treatments for OUD and is expanding in South Dakota:
  1. Comparison of OUD Medications To Guide Shared Decision Making
  2. Reference SAMHSA’s Treatment Improvement Protocol for MAT
Select the patient’s treatment plan:
  1. Appropriate for MAT or other treatment options
  2. NOT Appropriate for MAT, but may be appropriate for other treatment options

Patient Not Appropriate for MAT

Provide Education, Refer to a Primary Care Provider, and Prescribe Naloxone
  1. Provide education on harm reduction, resources, and encourage treatment
  2. Refer to a primary care provider or find a community health clinic and/or resources via the Helpline’s 211 service.
  3. Find a behavioral health provider via Care Coordination
  4. Prescribe or co-prescribe naloxone

Screening Complete! Start a New Screening

Patient Appropriate for MAT

Recommend and explain treatment

Reminder: your assessment and recommendation for treatment can make all the difference in the lives of your patients and their families. Thank you for helping educate and support efforts that move individuals toward recovery.

For more on how you can help, please explore the Education and Clinical Resources below.

Recommend and explain treatment

Reminder: your assessment and recommendation for treatment can make all the difference in the lives of your patients and their families. Thank you for helping educate and support efforts that move individuals toward recovery.

For more on how you can help, please explore the Education and Clinical Resources below.

Patient Agrees to MAT

Connect to treatment and support:
  1. Initiate MAT in ED or refer to MAT provider in South Dakota.
  2. Provide education on harm reduction, resources, and encourage treatment.
  3. Prescribe or co-prescribe naloxone.
Refer to:
  1. Care Coordination
  2. Resource Hotline

Reminder: Recovery is different for everyone. The more support your patients can get from providers, behavioral health specialists, family, and peer groups—the better the chances of successful outcomes. These services support the whole person and their community.

For more on how you can help, please explore the Education and Clinical Resources below.

Screening Complete! Start a New Screening

Patient Declines MAT

Provide Education, Encourage Care Coordination, Refer to a Primary Care Provider, and Prescribe Naloxone
  1. Provide education on harm reduction, resources, and encourage treatment.
  2. Prescribe or co-prescribe naloxone
  3. Refer to a primary care provider. Find a community health clinic and/or resources via the Helpline’s 211 service
  4. Find a behavioral health provider via Care Coordination.

Screening Complete! Start a New Screening

Thank you for using the Emergency Department Provider Toolkit!

As we work together to share ideas and information geared to improve patient outcomes and support transitions to recovery, we welcome your feedback.

We also encourage you to reference the Education and Clinical Resources, MAT information and providers and contact the South Dakota Association of Healthcare Organizations (SDAHO) for technical assistance.

Additional Detail & Resources

Is this an opiate drug-seeking patient?
Clinical Opiate Withdrawl Scale (COWS) is used to determine opiate withdrawal.

Can you get a brief patient self-assessment?
The Current Opioid Misuse Measure (COMM) can be used to determine if a patient is misusing an opioid prescription.

What can be used to predict aberrant medication behavior in adults with chronic pain?
The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument

How can I assess patient risk?
The National Institute on Drug Abuse offers a Quick Screen that can be used to identify risk behavior/risky substance use for patients 18 and older

Thank you for using the Emergency Department Provider Toolkit!

As we work together to share ideas and information geared to improve patient outcomes and support transitions to recovery, we welcome your feedback.

We also encourage you to reference the Education and Clinical Resources, MAT information and providers and contact the South Dakota Association of Healthcare Organizations (SDAHO) for technical assistance.

Additional Detail & Resources

Thank you for using the Emergency Department Provider Toolkit!

As we work together to share ideas and information geared to improve patient outcomes and support transitions to recovery, we welcome your feedback.

We also encourage you to reference the Education and Clinical Resources, MAT information and providers and contact the South Dakota Association of Healthcare Organizations (SDAHO) for technical assistance.

Thank you for using the Emergency Department Provider Toolkit!

As we work together to share ideas and information geared to improve patient outcomes and support transitions to recovery, we welcome your feedback.

We also encourage you to reference the Education and Clinical Resources, MAT information and providers and contact the South Dakota Association of Healthcare Organizations (SDAHO) for technical assistance.

Additional Detail & Resources

Thank you for using the Emergency Department Provider Toolkit!

As we work together to share ideas and information geared to improve patient outcomes and support transitions to recovery, we welcome your feedback.

We also encourage you to reference the Education and Clinical Resources, MAT information and providers and contact the South Dakota Association of Healthcare Organizations (SDAHO) for technical assistance.

Scroll To Top