Inpatient Management Plan
Planned approaches can help to ensure the safety of hospital staff and patients
with current substance abuse histories. These approaches can help control manipulative behaviors by patients, maintain surveillance of illicit
drug use, avoid conflicts surrounding the use of medications appropriately
used for pain and symptom control, and communicate knowledge of pain and
substance abuse management.
If possible, patients with current substance abuse issues who are scheduled for
surgical procedures should be admitted to the hospital several days early to
permit stabilization of the drug regimen. This period can be used to prevent
withdrawal and provide an opportunity to judge the need for alteration of the
plan established on admission.
A variety of actions can be considered in developing appropriate guidelines for
the specific concerns posed by a patient. Some patients may be given a
private room close to the nursing station to allow for monitoring. Patients
may be restricted to their rooms or floors until the danger of withdrawal or
illicit drug use is judged to be diminished. It can be appropriate to require
a patient to wear hospital pajamas to reduce the risk of departure from the
hospital to buy drugs. A patient’s visitors can be limited to family and
friends known to be drug-free. Visitors can be told that check-in with the
staff is required before contact with a patient is made.
Some patients should undergo one or more searches of their hospital rooms. If
illicit drugs, previously prescribed medications, or alcohol are discovered,
the items should be removed and discarded in accordance with hospital protocol.
Packages brought to the hospital by family members and friends can be searched
by responsible staff to ensure that they do not contain illicit drugs or
alcohol.
In some cases, it is useful to require periodic urine drug screening. To
simplify this process, the patient can be instructed to provide a daily
specimen. Some of these specimens are sent for analysis, and others are
discarded. The frequency of screening depends on the behaviors observed in the
hospital. This approach establishes the concept of regular surveillance for
the patient, without excessive use of the laboratory.
Again, this plan must be tailored to reflect the degree of risk perceived by
the staff. In some cases, no special requirements are needed, and in others,
the severity of recent abuse indicates the need for maximal caution. In
discussions with patients, staff can emphasize that the
implementation of these guidelines is in the best interests of the patient and
institution. Aggressive medical management unencumbered by doubts about the
history and concerns about ongoing drug use is possible only if the staff can
be reassured that drug abuse is not occurring.
Once a structure is established to control drug use, the medical management of
the active abuser must proceed attentively. Frequent visits are usually needed
to assess and manage symptoms. Drug withdrawal should be prevented, and
prescribed drugs for symptom control should be administered regularly,
to the greatest extent possible. This avoids frequent
encounters with staff that focus on the patient’s desire to obtain a drug.[1,2]
References
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Passik SD, Portenoy RK, Ricketts PL: Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis. Oncology (Huntingt) 12 (4): 517-21, 524, 1998.
[PUBMED Abstract]
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Passik SD, Portenoy RK, Ricketts PL: Substance abuse issues in cancer patients. Part 2: Evaluation and treatment. Oncology (Huntingt) 12 (5): 729-34; discussion 736, 741-2, 1998.
[PUBMED Abstract]
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