206 DR HOPE: reducing drug-related harm to outreach proactively from emergency care

Introduction: Drug use is estimated to cause over half a million deaths globally each year, with almost 80% involving an opioid.1 Scotland’s drug death rate of 327 per million population annually is the highest recorded in Europe (National Records of Scotland.2 Despite incremental improvements over the last few years across Scotland the number of Drug-Related Deaths in the Highlands continues to rise.2 Proactive outreach of those most at risk of drug-related harm is thought to offer a protective effect. However, current processes were not timely enough for urgent outreach. A Trigger Checklist was developed which includes two screening questions and a further ten background questions. A ‘yes’ response to either of the screening questions initiatives assertive outreach.

Aim: To test and implement the use of the Trigger Checklist and assertive outreach within 48 hours for those at high risk of drug-related harm within the local rural Emergency Department.

To identify mechanisms which explain how and why the Trigger Tool is completed some of the time in the ED and under what circumstances.

Methods: The project will be tested and implemented using the Model for Improvement.3 Small scale Plan, Do, Study, Act cycles were used to test and adapt the Trigger Checklist and referral pathway within a rural Emergency Department. Realist methodology will be used to determine causation of the mechanisms causing various behaviours.4Context, Mechanism and Outcome (CMO) configurations were devised and continually refined using literature and interviews with key stakeholders in the ED.

Results: Data collection remains ongoing, but to date 27 Trigger Checklist have been received from the ED. Of those, all were attempted to be outreached by recovery workers within 48 hours of the trigger. Of the 27, 19 (79%) were supported within 48 hours, 2 were outreached within 7 days, 2 were inappropriate referrals, 1 was referred to another recovery service and 3 were not outreached. CMO configurations have reduced from 36 to 22 and stakeholder interviews continue.