Tiny Tip: MORPH as a discharge guide for patients with substance use disorders

In Tiny Tips by Nicole MathiesLeave a Comment

Emergency Departments are often the primary source of healthcare for marginalized patients with substance use disorders.​1​ As such, we have unique opportunities to intervene and initiate change. While many acronyms and screening tools exist to identify substance use disorders, I have yet to find one that helps cover high yield items to be discussed with patients prior to discharge.​2​ In response, I created a clever, easy to remember tool based on case management practices that I use on every shift to ensure my patients with addictions have been fully cared for.​3​ My goal is that this will help in your practice as well.

MORPH

Patients may have a MORPHine or other addiction, and our treatment should involve MORPHing our approach to each patient.

Medical Care– Have I treated all medical needs? Do they need detox vs inpatient care or a specialist referral?

Opinion– Does my patient feel heard?

Relationship Safety- Are they safe at home? Is there suicidal ideation? Is there risk of domestic violence? Are children involved?

Plan in place- What are the next steps? Do they agree? What does their next day/week look like?

Housing– Are basic needs such as housing and food being met?

References

  1. 1.
    Hawk K, D’Onofrio G. Emergency department screening and interventions for substance use disorders. Addict Sci Clin Pract. Published online August 6, 2018. doi:10.1186/s13722-018-0117-1
  2. 2.
  3. 3.
    Najavits L. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. The Guilford Press; 2003.

Reviewing with the Staff

The COVID-19 pandemic has amplified housing, employment and income insecurity, substance use, discrimination and these issues are now accompanying patients to our Emergency Departments (ED). May front-line clinicians are already suffering provider burnout and other illnesses related to the COVID-19 pandemic and so there is an urgent need for efficient and evidence based approaches to address the needs of marginalized patients with complex social issues. Rapid effective care strategies increase a sense of professional autonomy and improve work satisfaction, and for this reason we present this practical tip from the new CMAJ homeless health guidelines (2020) to prevent negative outcomes from precarious housing and substance

We present the fifth vital sign for ER clinicians in the form of a medical mnemonic. The H.O.U.S.E. mnemonic reframes the ER approach to marginalized patient interactions, highlighting the importance of permanent housing, income interventions, and harm reduction strategies. Similar to the ACLS acronyms, H.O.U.S.E enables an evidence and needs-based empathic approach to prevent precarious housing within and ED that can alter life course trajectories. The ER might be the patient’s first and only point of contact with the healthcare system and similar to myocardial infarctions, we cannot let preventable illnesses slip through the cracks.

Kevin Pottie, MD, CCFP MClSc FCFP
Dr. Kevin Pottie is a professor of family medicine and epidemiology and community medicine and a clinical investigator at the Bruyere Research Institute, University of Ottawa. A former ER doc, his novel research methods bring evidence-based medicine to homeless, refugees and migrants and frail elderly populations.
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Nicole Mathies

Nicole Mathies

Nicole Mathies is a medical student at the University of Ottawa. Her academic interests include advocacy efforts in the areas of homelessness, HIV burdened communities, and microaggressions. She hopes to eventually combine her love for Emergency Medicine with Addictions Medicine and continue advocating for marginalized populations.