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The Difference One Nurse Can Make

The Difference One Nurse Can Make. A dedicated Withdrawal management (WDM) nurse on an adult inpatient mental health unit. Withdrawal management program. Central LHIN Medically supervised withdrawal management 4 beds Inpatient mental health unit . Withdrawal Management Program .

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The Difference One Nurse Can Make

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  1. The Difference One Nurse Can Make A dedicated Withdrawal management (WDM) nurse on an adult inpatient mental health unit

  2. Withdrawal management program • Central LHIN • Medically supervised withdrawal management • 4 beds • Inpatient mental health unit

  3. Withdrawal Management Program • Elective service • Planned admissions • Treatment planning group once weekly prior to admission • Daily contact with team and WDM psychiatrist

  4. The Challenges • Multiple inpatientnurses for withdrawal management patients • Inconsistent care • Varying levels of comfort level/knowledge base re: addiction issues and addiction population • Expectations were inconsistently reinforced • Frequent “staff splitting” • Poor coordination of care • High level of conflict between staff and WDM patients • Discharges AMA

  5. Goals • Improve care coordination • Reduce AMA discharges • Increase patient satisfaction • Increase staff satisfaction • Increase knowledge regarding withdrawal management and addiction issues in nursing staff • Improve relationship between program staff

  6. The Intervention • One dedicated WDM nurse during the day shift (0730h – 1530h) • Monday to Friday • Rotate through a period of 6 weeks • Manage all WDM admissions and discharges • Provide nursing care for all WDM patients

  7. The Effects • Consistency, predictability • Nurse with high level of interest in addiction population • Nurse with high and/or increasing level of knowledge base re: addiction issues/WDM protocols • Expectations consistently reinforced • Daily meetings between team and patient = minimize staff splitting • Quality of coordination improved – one “go-to” person on inpatient floor • Stronger, more consistent advocacy for WDM patients.

  8. Effects on discharges AMA? • Pre-implementation period (12 months) • 19 discharges AMA • Post implementation period (12 months) • 14 discharges AMA

  9. AMA discharges… • 14 discharges during 12 month post implementation period • Discharges during evening shift: 5 • Discharges during weekend shift: 5 • A total of 10 patients out of 14 • 71.4% of all unplanned discharges occurred when the designated WDM nurse was NOT on duty!

  10. Implications • Need for dedicated WDM nurse during each shift? • Need for dedicated WDM nurse during weekends?

  11. Results of Staff Survey: “The quality of care for WDM patients improved since implementing the WDM role on day shift.” 83% of staff agreed “There is less conflict between WDM patients and staff with the implementation of the WDM role.” 83% of staff agreed “It was better when the WDM patients were divided among all staff.” 74% of staff disagreed

  12. Comments from staff • “There should be a WDM nurse on all shifts” • “It should be D/E/N for consistency. It defeats the purpose when (the WDM patients) are split up after 3:30 pm.” • “Drug addicts should not be placed with vulnerable elderly patients.”

  13. Results from Patient Survey • “I like having the same nurse take care of me Mon-Fri during the day.” • 93% agreed • “I feel more comfortable talking to the withdrawal management nurse about my problems than the regular nurses.” • 86% agreed • “I am less likely to leave before my treatment is complete if I am under the care of the withdrawal management nurse.” • 93% agreed

  14. Patient comments • “My daytime nurse Liz worked well with Dr. Styrsky. I can’t say the same for evening and weekend staff.” • “I feel the withdrawal management was very helpful and helped me a lot.” • “On several occasions I didn’t know who my evening nurse was and while sick in bed, I would have to go looking for them.” • “While inquiring politely at the nurses station you are usually met with indifference…there seems to be an attitude of “I’m not your nurse.”

  15. Concepts and Issues • Stigma against addiction/WDM patients • Knowledge base re: addiction

  16. Review: • Implementation of dedicated WDM nurse: an effective solution! • Improved quality of care for detox patients • Increased patient and staff satisfaction • Reduction in AMA discharges

  17. Questions

  18. The Difference One Nurse Can Make • Effects on rates of discharges AMA post implementation of a dedicated Withdrawal Management (WDM) inpatient nurse

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