158 - Leveraging National Accreditation Application Process to Improve and Standardize Pediatric Pain and Addiction Care in the Emergency Department (PACED)

Poster Number: 158
Publication Number: 158.529

Background: Substance use is a public health issue, including within our adolescent population. 1 in 4 who use alcohol or drugs before the age of 18 will develop a substance use disorder. Emergency Departments (EDs) support communities in times of crisis, including substance use and pain care needs. Pain and Addiction Care in the Emergency Department (PACED) is a national accreditation program by the American College of Emergency Physicians (ACEP) that seeks to motivate improvement and implementation of quality, evidence-based care.

Objective: Our objective was to leverage the PACED application process for our pediatric ED to facilitate development and implementation of strategies to address substance use and pain while minimizing opioid use.

Design/Methods: The application process created a climate conducive to driving change. To apply, we inventoried current programs and protocols and identified opportunities for improvement. Current practices included Screening, Brief Intervention, and Referral to Treatment (SBIRT) and the Naloxone Saturation Campaign (NAL-SAT), providing opioid overdose prevention education and a no-cost naloxone rescue kit. Site champions and stakeholders were engaged to collate current pain and addiction care practices and identify where gaps were for the bronze accreditation.

Results: We implemented strategies to fill gaps in care. The clinical team was re-educated on SBIRT and NAL-SAT for substance use, and on protocols for pain care. Newly written or emphasized pain care included protocols for both non-pharmacologic (ice packs and hot compresses) and non-opioid pharmacologic (oral ibuprofen and acetaminophen, intranasal Midazolam) methods. Education included importance of starting low with dosage of opioid and non-opioid medications and increasing slowly to control pain.

For substance use, the conversation starts with screening. Following the pandemic and tripledemic, in early 2022, screening rates were down to 5-6%, and only about 13% of patients with a positive screen received further services. During PACED application and award period, screening doubled to a consistent 10-11%, and a new adolescent referral to treatment resource list was developed

Conclusion(s): Cohen Children’s Medical Center is the FIRST pediatric ED to achieve PACED accreditation. The process established a framework and goals for improving care. Strategies implemented will serve as a model for standardizing care across the other 16 EDs that serve adolescent patients. Next steps include evaluation of protocol adoption and patient care outcomes.