Evidence-based guidelines for responding to acute care and support needs

Evidence-based guidelines for acute care support

• Welcome to this resource.

• Here we will explore the evidence-based guidelines for responding to acute effects of misused substances.

• We will not be examining emergency and crisis care itself as that is provided in the resource entitled ‘immediate or crisis action’.

Outcomes

Specific outcomes will be to:

• Identify the current guidelines for acute care.

• Outline the range of responses in different settings and areas of practice.

• Refer to further guidance and update resources.

What are acute care needs?

• Our definition here encompasses the scope of health and social care practice contexts.

• However, we will focus on physical, psychological, and social needs, in the short term.

Physical needs

Acute intoxication can put someone in danger for many reasons.

Three key ones may be:

1. Risk of overdose/poisoning.2. Risk of accidents.3. Risk of harming others.

Signs of overdose - depressants• Signs of overdose from

depressants will include drowsiness, lethargy, constricted pupils, slurred speech, reduced breathing rate.

• These will require emergency medical treatment and the person needs to be taken to the accident and emergency department.

• There, the person will receive antidote medication to counter the effects of the overdose.

Signs of overdose: stimulants & hallucinogens

• Signs of intoxication and overdose from stimulants or hallucinogens will include over-activity, elation, giggling, raised vital signs, aggression.

• There may also be psychosis (hallucinating, feelings of persecution, expressing strange ideas).

• These will require hospital treatment due to risk of cardiovascular accident (stroke, cardiac arrest).

• Psychosis will need medical assessment and treatment.

Toxicity

• Overdose and poly drug use are common forms of poisoning.

• Using too much of a drug or stronger mixtures of it, and using it with another substance, which enhances its effects, is common.

• People who have overdosed may try to counteract the effects by using something else on top.

• Excessive drowsiness, over-activity, vomiting or wayward behaviour are signs of the need for urgent medical attention.

Risk of accidents• Intoxication from a depressant drugs puts the person at risk from a

lack of self protection.

• They are also at risk of vomiting and choking. • Someone who is drunk or comatose should be placed in the

unconscious position - to avoid inhalation of gastric contents - and be monitored.

• They are at risk of exposure, postural asphyxiation and dehydration.• A person should not be left alone if likely to become

unconscious. They need positioning and warmed up/cooled down. Give fluids if conscious. Hospitalise if unresponsive.

Risk of accidents (cont.)

• Intoxication on stimulants or hallucinogens can provoke risk taking behaviour.

• They may engage in daredevil acts or be unaware of environmental dangers. They may attempt to go swimming, walk on railway tracks, run across roads or even drive.

– As a health or social care professional, you have a duty of care to a person you know is in acute risk from substance use.

– If you are unable to manage the person’s condition, you need to contact emergency services to ensure the person is in a place of safety – this could be a police cell or A & E!

Alcohol intoxication: risk to others• Driving. It is illegal to drive in England with a blood alcohol level above

80mgs/100mls vol. This is not very much and likely to be reduced in line with Scotland and Europe at 50mgs/100mls vol. in the near future.

• See the case study in this resource for an illustration of professional responsibility in relation to drink driving.

• It is illegal for someone to be in sole charge of a young child if they are intoxicated (with alcohol or any other psychoactive drug).

• This puts the child in danger as there is no responsible adult to keep them safe.

• It is your responsibility to ensure the safety of a minor, or other vulnerable person, if they are not supervised. See the resource on Safeguarding for more on this.

Alcohol intoxication: risk to others

• Domestic and other violence. Domestic violence affects the partner and any other member of the family in the household – as well as the perpetrator.

• You are responsible for the safety of others if you have clear suspicions of domestic violence.

• See the resource Domestic violence and substance use for more on this. Also, see the resources for Supporting family members and Impact on children and Impact on family carers and parents.

Stimulants and hallucinogens: risk to others

• These substances can cause temporary or enduring psychotic states. This may include feelings of persecution and hallucinating.

• While many people in this state are more likely to harm themselves, they can be aggressive towards others.

• Someone exhibiting psychotic symptoms needs psychiatric assessment and may require control using the Mental Health Act. A GP or a psychiatrist is normally the person able to section someone under the Act in order to keep them safe.

• A police officer is also empowered to arrest someone who may be suffering a mental illness and is a danger to themselves or others.

Professional standards• HCPC (2012) Standards of conduct, performance and ethics.

http://www.hcpc-uk.org/aboutregistration/standards/standardsofconductperformanceandethics/

• NMC (2015) The Code: Professional Standards for Practice and Behaviour for Nurses and Midwives. Available at: http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

Evidence and sources of information • Department of Health (England) and the devolved administrations (2007). Drug Misuse and

Dependence: UK Guidelines on Clinical Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive.

• Ghodse A H (2002) Drugs and addictive behaviour: A guide to treatment. 3rd edition. Blackwell Science. Oxford.

• NICE (2012) Quality Standards for Drug Use Disorders. National Institute for Clinical Excellence. Quality Standard 23.

• NICE (2010) Alcohol-use disorders: preventing the development of hazardous and harmful drinking. National Institute for Health and Clinical Evidence, Public Health Guidance 24.

• NICE (2007) Drug Misuse: psychosocial interventions. National Institute for Health and Clinical Evidence Clinical Guideline 51.

• Rassool G H (1998) Substance Use and Misuse: Nature, Context and Clinical Interventions. Oxford, Blackwell.

• Rassool G H (2009) Alcohol and Drug Misuse: A Handbook for Students and Health Professionals. Oxford, Blackwell.

• Parsons G (2015) Illicit drug overdose: managing emergency care. The Pharmaceutical Journal. Available at: http://www.pharmaceutical-journal.com/learning/cpd-article/illicit-drug-overdose-managing-emergency-care/20068355.cpdarticle