BERT Behavioral 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
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.______________________________________
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
