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Across the Continuum….. Managing the Inpatient
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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
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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
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Substance Withdrawal Committee
Multidisciplinary Psychiatry Pharmacy Nursing Informatics Trauma Safety Crisis
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7% Statistics Adult National Alcoholism Rate
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Statistics 17 million adults
2.6 million with alcohol plus other substance addiction
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Alcohol/DT admission = 103
Statistics Community Alcohol/DT admission = 103
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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
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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
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Screening Tool Audit-C Standardized tool Screen on admission
Alert to contact MD Facilitate monitoring/treatment
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Screening Tool Scores >3 Requires further assessment
Physician notification
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Audit-C
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Inpatient Screen In past 6 months, out of 2,879 screenings:
30% of patients scored >4 7% of these patients had score of 12
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Patient Case Audit-C = 12 on admission
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Monitoring Tool Clinical Institute Withdrawal Assessment (CIWA-Ar)
Series of questions/observations Detects progression
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Patient Case CIWA range of 10-20
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Treatment Algorithm Computerized order set Nursing driven
Decision support Ancillary orders Nursing driven
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Treatment Algorithm
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Patient Case
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Counseling Referral Discharge Resources
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Patient Case Mr.K opted for inpatient management
Placement into treatment facility
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Future Goals Committee expansion Address ALL Substance Withdrawal
Guidance Increased resources
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