Care of the Intoxicated Patient

1. Care of the Intoxicated Patient Cassandra Kotlarczyk Ferris State University

2. Overview • Information was gathered from other hospitals on their discharge criteria of intoxicated individuals • Research performed on the standard of care for proper evaluation, assessing, charting and discharge • Interdisciplinary team put together consisting of a nurse, assistant department manager (ADM), emergency department (ED) attending physician, security personnel, and someone from Risk Management • In-service and education provided to staff

3. Purpose • Work in largest emergency department (ED) in Lansing, five miles from Michigan State University’s campus • Bombarded with intoxicated students (January, February, March 2013 attended to 320 alcohol intoxicated individuals between the ages of 17-26) • No consistent way to assess, manage, or discharge • The purpose of this project to ensure all healthcare providers are on the same page and give high quality, consistent care (Sparrow Database, 2013)

4. Goals & Objectives Goal:to implement a protocol for the functionally intoxicated college age students (ages 17-26) that allow for safe, consistent discharge criteria by July 15, 2013 Objectives: • Meet with assistant department manager to discuss topic • Obtain information from other hospitals on any protocols they have in place • Research current information • Put together an interdisciplinary team to work on project • Create protocol based on current evidence-base practices and research • Notify and educate staff • Perform trial run of protocol • Survey staff in ED on effectiveness of new protocol • Meet with team and make any necessary adjustments before going live

5. Culture of Quality & Safety • Ages 19-24 have the highest prevalence of periodic heavy alcohol consumption (binge drinking) in an individual’s life span (Johnston, 2000). • Alcohol consumption by college students linked to 1,400 deaths and 500,000 unintentional injuries each year (National Institute, 2002). • One in three 18 to 24 year-olds are admitted to the ED for serious injuries related to intoxication (U.S., 1999). • Average length of staff of intoxicated individuals in my ED was 288.53 minutes or 4.81 hours in from January to March 2013 (Sparrow Database, 2013). • Need to have a protocol in place to ensure proper assessment and treatment performed. Also, need to have a safe way to discharge intoxicated individuals that do not need to be in the ED. This project focuses on doing that.

6. Process, Progress, & Completion • Everyone that I spoke to about this project was very receptive. • The project did not progress at the rate I thought it would. Our original date for trial run was July 15, 2013. • Date has been moved back to August 22, 2013. • Educational teachings to staff have been moved back and are being completed this week. • IT continues to work on our computer charting system

7. Obstacles & Challenges • There were a lot of summer vacations that were already planned that prevented us from being able to meet. • The date was pushed back for the trial period because the census of this population is low in the summer. • Finding evidence-based research on this topic was difficult. There is not a lot of information out there from a nursing perspective.

8. Ethical/Professional Issues • The biggest ethical issue is ensuring that a patient is not discharged if it is not safe to discharge them, this is why this project was done. • There were no other ethical issues. There is the legal issue concerning an intoxicated 17 year-old that we are still trying to come to a census on. • One of the professional issues was that there were a lot of people taking vacations at different times. This made meeting and discussing the project challenging at times. • The only other professional issue is that I was not able to inform and teach everyone about the new protocol.

9. Lessons Learned As a nursing leader I grew by: • Being a more effective communicator • Becoming more organized • Improving my multitasking skills • Educated my peers which was really scary • More open to the idea of change

10. Lessons Learned Collaborative Leadership • I work with many different disciplines so that was not new for me, but I have never been the leader of this group so I was very nervous • I learned how to use the resources of people around me • I learned to take a step back and not be afraid to delegate tasks • At no point did people not get along. Everyone was very respectful and helpful.

11. References • Escott, M. E. A. Evaluation and Disposition of the Intoxicated Patient [PowerPoint slides]. Retrieved from Lecture Notes Online Web site: http://www.ncemsf.org/about/conf2010/presentations/escott_intoxicated_patient.pdf • Johnston, C. P. (2000). Monitoring the Future National Survey Results on Drug Use. Secondary School Students, 1. NIH Publication No. 01-4924. Bethesda, MD: National Institute on Drug Abuse. Retrieved from: www.brad21.org/facts.html • Kapp, M. B. (1999). Physical Restrain Use in Acute Care Hospitals: Legal Liability Issues. Marquette Elder’s Advisor, 1 (1). Retrieved from: http://scholarship.law.marquette.edu/elders

12. References • The National Institute on Alcohol Abuse and Addiction, (2002). Alcohol Alert, 58:1-4. • Sparrow Database (2013). Sparrow Intranet • U.S. Substance Abuse and Mental Health Administration, Office of Applied Studies. (1999) Summary of Findings from the 1998 National Household Survey on Drug Abuse. Rockville, MD. Retrieved from: http://www.brad21.org/facts.html