1. Across the Continuum….. Managing the Inpatient

2. Substance Withdrawal Committee
Multidisciplinary
Psychiatry
Pharmacy
Nursing
Informatics
Trauma
Safety
Crisis

3. Objectives Describe treatment of inpatient addiction issues
Explain the challenges of the stigma of addiction
Develop a system of discussion around the issues surrounding addiction

4. Today’s Panel Participants
Maureen L. Small, RN Trauma Program Manager
Laura Gartner MS, BSN, RN Clinical Informatics Specialist
Michael Sangirardi, MSN, RN Associate Director 3 Buerger Outpatient Observation
Karen Fithian, LCSW
Crisis Coordinator
Danielle Schulingkamp, RPh, BCPS, BCCCP
Clinical Specialist Critical Care/Surgical Trauma

5. Statistics Adult National Alcoholism Rate (audience response)

6. Statistics 6.4% (17 million adults)
2.6 million with alcohol plus other substance addiction

7. Statistics
Community (audience response)

8. Statistics Alcohol Withdrawal Admissions Delirium Tremens Admissions
(waiting for crimson data)

9. Delirium Tremens Symptoms: Delirium Tremulousness Agitation
Tachycardia
Hypertension
Diaphoresis
Mortality:
<5% with treatment
Down from 35% without treatment
Complications of Alcohol Withdrawal: Pathophysiological Insights
pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf

10. Patient Case
KK is a 40yo man admitted to the ER with alcohol intoxication
Other symptoms include dizziness and lightheadedness
History includes
Alcoholism
Cirrhosis
Depression

11. Screening Tool Audit C Standardized tool Screen on admission
Alert to contact MD
Facilitate monitoring/treatment

12. (insert audience participation)

14. Inpatient Screen Scores >3 In past 6 months:
Requires further assessment
Physician notification
In past 6 months:
30% of patients screened were >4
7% of these patients had score of 12

15. Patient Case
Audit-C = 12 on admission

16. Monitoring Tool Clinical Institute Withdrawal Assessment (CIWA-Ar)
Series of questions/observations
Detects progression
(insert ciwa clip 2:54-4:08)

17. Patient Case
Admission: 10
Later that day 11
Day 2: 13

18. Treatment
Algorithm
Computerized order set
Nursing driven

19. Patient Case

20. Counseling
Referral
Discharge
Resources

21. Patient Case KK opted for inpatient management
Placement into treatment facility

22. Future Goals Delirium Tremens Protocol
Address ALL Substance Withdrawal
Guidance
Increased resources