Across the Continuum….. Managing the Inpatient

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Presentation transcript:

Across the Continuum….. Managing the Inpatient

Today’s Panel Participants Maureen L. Small, RN, BSN Trauma Program Manager Laura Gartner MS, BSN, RN Clinical Informatics Specialist Michael Sangirardi, MSN, RN Associate Director 3 Buerger Outpatient Observation Karen Fithian, LCSW Crisis Coordinator Danielle Schulingkamp, RPh, BCPS, BCCCP Clinical Specialist Critical Care/Surgical Trauma

Objectives Describe treatment of inpatient addiction issues Explain the challenges of the stigma of addiction Develop a system of discussion around the issues surrounding addiction

Substance Withdrawal Committee Multidisciplinary Psychiatry Pharmacy Nursing Informatics Trauma Safety Crisis

7% Statistics Adult National Alcoholism Rate http://www.samhsa.gov/atod/alcohol

Statistics 17 million adults 2.6 million with alcohol plus other substance addiction www.niaaa.nih.gov

Alcohol/DT admission = 103 Statistics Community Alcohol/DT admission = 103

Delirium Tremens Symptoms: Delirium Tremulousness Agitation Tachycardia Hypertension Diaphoresis Mortality: <5% with treatment Down from 35% without treatment Complications of Alcohol Withdrawal: Pathophysiological Insights pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf

Patient Case Mr.K is a 40yo man admitted to the ER with alcohol intoxication Other symptoms include dizziness and lightheadedness History includes Alcoholism Cirrhosis Depression Labs: Abnormal LFTs ETOH level = 444

Screening Tool Audit-C Standardized tool Screen on admission Alert to contact MD Facilitate monitoring/treatment

Screening Tool Scores >3 Requires further assessment Physician notification

Audit-C

Inpatient Screen In past 6 months, out of 2,879 screenings: 30% of patients scored >4 7% of these patients had score of 12

Patient Case Audit-C = 12 on admission

Monitoring Tool Clinical Institute Withdrawal Assessment (CIWA-Ar) Series of questions/observations Detects progression

Patient Case CIWA range of 10-20

Treatment Algorithm Computerized order set Nursing driven Decision support Ancillary orders Nursing driven

Treatment Algorithm

Patient Case

Counseling Referral Discharge Resources

Patient Case Mr.K opted for inpatient management Placement into treatment facility

Future Goals Committee expansion Address ALL Substance Withdrawal Guidance Increased resources

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