Reducing drug-related harm by triggering proactive outreach.

Drug-related deaths (DRDs) remain a global issue, with Scotland reporting the second-highest rate per million population. Although some areas have seen improvements, DRDs continue to rise in parts of the Scottish Highlands. Proactive outreach to those at highest risk is believed to reduce harm. This project tested and implemented a risk identification tool-the Trigger Checklist (TC)-to initiate assertive outreach in a remote Highland area by September 2023.The Model for Improvement was used to structure the improvement process. This included collaborative exploration of the problem and solution, development of the TC, devising a family of measures and Plan, Do, Study, Act cycles to structure interactive learning and refinement of the TC and outreach process. Data were collected on the number of completed TC, the percentage of those outreached within 48 hours and the number of days between incidents of non-fatal overdoses (NFOD). Timely staff experience feedback was gathered using a visual facial analogue scale.A standardised TC was devised and tested. 48 TCs were received over 8 months. Of those 100% (n=48) were assertively outreached within 48 hours of a TC referral. The median number of days between NFOD increased from 6.5 days (January-August 2022) to 23 days (September 2022-August 2023). There was an increase in the number of days between incidents of NFOD locally, with more than 90 days between two events (previously the maximum number reached was 48). For the duration of the project, the locality did not receive a DRD notification.There is a need to further test and standardise the use of the TC in other areas frequented by those most at risk of drug-related harm, such as the remote and rural emergency department.