elliot hospital, manchester new hampshire · 2018. 12. 6. · elliot hospital, manchester new...
TRANSCRIPT
BERTBehavioral Emergency Response Team
Beth Harmon, BSN, RN, BERT Resource Nurse
Heidi St. Hilaire, MSN, CNL, BSN, RN, Manager of Behavioral Health
Sandra Netto, LICSW, BERT Team Social Worker
Channon Leborgne, BSN, RN, BERT Resource Nurse
Elliot Hospital, Manchester New Hampshire
BERT Team
� Review The NH Heroin Epidemic
� Hospital Based issues
� Infection (Abscess, Endocarditis, Sepsis)
� Pain Management
� Withdrawal Management
� Against Medical Advice (AMA)
� Harm Reduction and Culture Change, a Case Study.
� Teaching Medical Bedside Staff how to care for Substance Use Patients
� Individualized Care Plans
Heroin related deaths in 2010- 2013 = 13 to 70 (5 fold increase)
Heroin related deaths in 2014 = 326
February 2014 NH declares a Heroin Epidemic
2015 = 439
2016 = 485, 349 fentanyl involved
The Epidemic kills one person from a OD every day in NH
A demographic of people require hospitalization for infections.
� Bacteremia
� *Cardiomyopathy
� *Endocarditis
� Detox
� Osteomyelitis
� Septic Emboli (Pulmonary, Spinal, Cerebral)
� Sepsis
� Soft Tissue Infections or Abscess
� Cellulitis
� Necrotizing fasciitis
“Most patients with an opioid diagnosis and an AMA discharge leave
within the first 5 days.”
“The most common length of stay for these patients is 2 days.”
Against Medical Advice
“What happens to patients who leave hospital against medical advice?”
� Readmission: increased 15 day and 30 day readmission rate
� Negative outcomes
� Continued consequences of the disease
� Increased length of stay LOS
� Increased mortality- one study found these patients were more likely to die in 6 months, but most studies show they have an increased 2 year mortality rate.
Against Medical Advice
How can a Behavioral
Emergency Response
Team work for you?
Case Study
Jade
33 year old female
Case Study---Jade 2015 – We begin to see Jade more frequently.______________________________________
2016 –Illness, behaviors, and addiction
Jade - 2017
A break through __________________________
Learning Objective # 1______________________________________
The importance of having a psychiatric social worker as part of the behavioral team.
The Stages of Change
Frequency
Follow Up Care
Mindfulness
Learning Objective # 2______________________________________How to help all staff understand and process their own feeling when a patient says or does
something on the unit that is disruptive to their care
How to help staff who are trying to help the patient
Stages of Change
Learning Objective # 3______________________________________How to instruct and model appropriate behavioral interactions to staff at bedside when working with the misuse population.
Angry & Stigmatizing
� But, I have patients who are really sick.
� They keep asking/demanding for things and they are swearing.
� They called me a bad nurse
� They deserve it. They put the needle in their arm or the stuff up their
nose.
� All they are doing is medication seeking, I don’t think they are really
in pain.
__________________________________________________________
� We should have a 3 times your out rule for Narcan
� I hope they leave AMA it would be so much better around here
NO!!!NO!!!NO!!!NO!!!
� It is wise to remember our ANA Nursing Code of Ethics.
Provision 1 says
“The nurse practices with compassion and respect for the inherent dignity, worth
and unique attributes of every person”. 7
Ethics
Learning Objective # 4______________________________________
Individualized Behavioral Care Plan’s
Jade
noun \ ˈjād \
Noun archaic
noun: jade; plural noun: jades
1. a bad-tempered or disreputable
woman.
2.an inferior or worn-out horse
�Compact gemstone that take a high polish
What was different this time?
Project Summary Successes
� Increased staff education CPI, 800 people in 2017
� Consistency for both patient and staff
� Teaching and modeling Harm Reduction
� Encouraging staff to be strength based
� Acknowledging fears are reality testing them in the moment
� Teaching that stigma would not be tolerated
Risk of Heroin use Handout
Abscess-is a pocket of pus in the deeper
layers of skin or tissue. Pus is a thick fluid that contains dead tissue, bacteria, and
white blood cells from your body that is trying to fight the infection. Bacteria
Endocarditis-is an infection of the inside
of the heart. Bacteria attaches to the lining of the heart or the heart valve.
Infected Clots (Septic Emboli)- pieces of
the vegetation in the heart can break away
from the heart valve, enter the blood
stream and get lodged in other organs, like
the brain causing strokes
Sepsis or Blood Infection- occurs when
the blood becomes infected with bacteria