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The Difference One Nurse Can Make

A dedicated Withdrawal management (WDM) nurse on an adult inpatient mental health unit

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Withdrawal management program

Central LHIN Medically supervised withdrawal

management4 bedsInpatient mental health unit

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Withdrawal Management Program

Elective servicePlanned admissionsTreatment planning group once weekly

prior to admissionDaily contact with team and WDM

psychiatrist

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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

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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

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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

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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.

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Effects on discharges AMA?

Pre-implementation period (12 months)19 discharges AMAPost implementation period (12 months)14 discharges AMA

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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!

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Implications

Need for dedicated WDM nurse during each shift?

Need for dedicated WDM nurse during weekends?

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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

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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.”

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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

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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.”

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Concepts and Issues

Stigma against addiction/WDM patients

Knowledge base re: addiction

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Review:

Implementation of dedicated WDM nurse: an effective solution!

Improved quality of care for detox patients

Increased patient and staff satisfactionReduction in AMA discharges

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Questions

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The Difference One Nurse Can Make

Effects on rates of discharges AMA post implementation of a dedicated Withdrawal Management (WDM) inpatient nurse