Care of the Intoxicated Patient

Cassandra KotlarczykFerris State University

OverviewInformation was gathered from other hospitals on their discharge criteria of intoxicated individualsResearch performed on the standard of care for proper evaluation, assessing, charting and dischargeInterdisciplinary 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

PurposeWork in largest emergency department (ED) in Lansing, fivemiles from Michigan State University’s campusBombarded 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 dischargeThe purpose of this project to ensure all healthcare

providers are on the same page and give high quality, consistent care

(Sparrow Database, 2013)

Goals & ObjectivesGoal: 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 topicObtain information from other hospitals on any protocols they

have in placeResearch current informationPut together an interdisciplinary team to work on projectCreate protocol based on current evidence-base practices and

researchNotify and educate staffPerform trial run of protocolSurvey staff in ED on effectiveness of new protocolMeet with team and make any necessary adjustments before

going live

Culture of Quality & SafetyAges 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.

Process, Progress, & CompletionEveryone 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

Obstacles & ChallengesThere 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.

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.

Lessons LearnedAs a nursing leader I grew by:Being a more effective communicatorBecoming more organizedImproving my multitasking skillsEducated my peers which was really scaryMore open to the idea of change

Lessons LearnedCollaborative LeadershipI 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.

ReferencesEscott, 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

ReferencesThe 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