Janet Butler is one of the Clinical Nurse Educators with the Royal Alexandra Hospital ARCH Program in Edmonton, Alberta. Janet shares her experience and reflections working in the hospital’s supervised consumption service. Edited for clarity and length.
Can you give a brief description of your site, including what services you provide?
It would be impossible to talk about the Royal Alexandra (Royal Alex) hospital-based supervised consumption service (SCS) without first talking about the Addiction Recovery and Community Health (ARCH) team. The ARCH team is a specialized addiction medicine consult service that is available to inpatients or emergency department patients at the Royal Alex. ARCH consults with patients who are actively using substances (drugs and/or alcohol) or who are experiencing complex social issues.
The team includes physicians and nurse practitioners, addiction counsellors and peer support workers, pharmacists, management and admin staff, social workers, clinical nurse educators, and the nurses who work in and support the SCS (registered nurses, registered practical nurses, and licensed practical nurses).
ARCH is supported by the Inner-City Health and Wellness Program (ICHWP), which has researchers who collect scientific evidence documenting the care of people with substance use disorders in an acute care setting - an area of study that has very little available resources. These researchers specifically work with and learn directly from patients, to understand their experiences and needs.
The ARCH program began in 2014 under the leadership of Dr. Kathryn Dong. Dr. Dong was then an emergency room physician who, over time, became frustrated with seeing marginalized community members present to the emergency department, and not be able to address their underlying issues that brought them there.
In 2014, with a grant from the Royal Alexandra Hospital Foundation, Dr. Dong assembled a small team and created the ARCH consult service. Later, an ARCH transition clinic was established, where patients could see a nurse practitioner. The clinic then expanded to seven days a week and added a social work team. The ARCH team strives to assist patients with obtaining housing, income support, picture ID, access to community resources, and anything else they may need.
How did your organization identify the need for a hospital-based supervised consumption service?
The data that the researchers collected through the ICHWP provided evidence of a need for SCS. With support from the Royal Alex Foundation grant, the ARCH team was able to open the SCS in April 2018. The first hospital-based SCS in North America!
Staffed by nurses and open 24 hours a day, the Royal Alex SCS is available to all inpatients and emergency department patients, including those waiting in the ED waiting room. The SCS nurses also provide valuable outreach support to patients and staff throughout the hospital and the ED.
Research has shown that if patients are using drugs before presenting to hospital, about 45 per cent will continue to use while in hospital. Prior to the existence of the SCS, our patients had no choice but to use in unsafe environments, such as stairwells, washrooms, or outside, and alone. The SCS provides a clean, well-lit, non-judgmental space where patients can safely use their substances, under the supervision of trained professionals, with access to the safer supplies that they need.
Does the site link patients to other services?
Yes. The staff are well informed about various community resources available and can ensure patients have the information they need to find them.
What are some of the challenges that your team has encountered?
Of the many challenges we’ve encountered, the absence of an inhalation space in our SCS is a big one, so we have collected patient surveys and are continuously assessing the need for this.
The SCS and the ARCH team aims to change the culture of our hospital, to make it a more welcoming, inviting, non-judgmental space. We are trying to change one small corner of the world, and provide support, engagement, and a safe place for our patients.