1
The Difference One Nurse Can Make
A dedicated Withdrawal management (WDM) nurse on an adult inpatient mental health unit
2
Withdrawal management program
Central LHIN Medically supervised withdrawal
management4 bedsInpatient mental health unit
3
Withdrawal Management Program
Elective servicePlanned admissionsTreatment planning group once weekly
prior to admissionDaily contact with team and WDM
psychiatrist
4
The Challenges
Multiple inpatient nurses for withdrawal management patients
Inconsistent careVarying levels of comfort level/knowledge base
re: addiction issues and addiction populationExpectations were inconsistently reinforcedFrequent “staff splitting”Poor coordination of care High level of conflict between staff and WDM
patients Discharges AMA
5
Goals
Improve care coordinationReduce AMA dischargesIncrease patient satisfactionIncrease staff satisfactionIncrease knowledge regarding withdrawal
management and addiction issues in nursing staff
Improve relationship between program staff
6
The Intervention
One dedicated WDM nurse during the day shift (0730h – 1530h)
Monday to Friday Rotate through a period of 6 weeksManage all WDM admissions and
dischargesProvide nursing care for all WDM
patients
7
The Effects
Consistency, predictabilityNurse with high level of interest in addiction populationNurse with high and/or increasing level of knowledge
base re: addiction issues/WDM protocolsExpectations consistently reinforced Daily meetings between team and patient = minimize
staff splittingQuality of coordination improved – one “go-to” person
on inpatient floor Stronger, more consistent advocacy for WDM patients.
8
Effects on discharges AMA?
Pre-implementation period (12 months)19 discharges AMAPost implementation period (12 months)14 discharges AMA
9
AMA discharges…
14 discharges during 12 month post implementation period
Discharges during evening shift: 5Discharges during weekend shift: 5A total of 10 patients out of 14 71.4% of all unplanned discharges
occurred when the designated WDM nurse was NOT on duty!
10
Implications
Need for dedicated WDM nurse during each shift?
Need for dedicated WDM nurse during weekends?
11
Results of Staff Survey:
“The quality of care for WDM patients improved since implementing the WDM role on day shift.”
83% of staff agreed“There is less conflict between WDM patients
and staff with the implementation of the WDM role.”
83% of staff agreed“It was better when the WDM patients were
divided among all staff.”74% of staff disagreed
12
Comments from staff
“There should be a WDM nurse on all shifts”
“It should be D/E/N for consistency. It defeats the purpose when (the WDM patients) are split up after 3:30 pm.”
“Drug addicts should not be placed with vulnerable elderly patients.”
13
Results from Patient Survey
“I like having the same nurse take care of me Mon-Fri during the day.”
93% agreed “I feel more comfortable talking to the
withdrawal management nurse about my problems than the regular nurses.”
86% agreed “I am less likely to leave before my treatment
is complete if I am under the care of the withdrawal management nurse.”
93% agreed
14
Patient comments
“My daytime nurse Liz worked well with Dr. Styrsky. I can’t say the same for evening and weekend staff.”
“I feel the withdrawal management was very helpful and helped me a lot.”
“On several occasions I didn’t know who my evening nurse was and while sick in bed, I would have to go looking for them.”
“While inquiring politely at the nurses station you are usually met with indifference…there seems to be an attitude of “I’m not your nurse.”
15
Concepts and Issues
Stigma against addiction/WDM patients
Knowledge base re: addiction
16
Review:
Implementation of dedicated WDM nurse: an effective solution!
Improved quality of care for detox patients
Increased patient and staff satisfactionReduction in AMA discharges
17
Questions
18
The Difference One Nurse Can Make
Effects on rates of discharges AMA post implementation of a dedicated Withdrawal Management (WDM) inpatient nurse