Practice Experience Responses: WK 1 Respond to at least two of your

Practice Experience Responses: WK 1

Respond to at least two of your classmates. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project. Provide support and suggestions on the importance of the practice problem in improving patient outcomes.

RESPONSE 1 : M. Baron 

RE: Group A Practice Experience Discussion – Week 1

COLLAPSE

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I am a Care Coordinator for an agency that provides in-home addiction treatment. It is a 52 week program where a direct team of 2 recovery advisors (peer support individuals) and a Care Coordinator whose role is usually filled by a nurse (and sometimes an LCSW).

A quality issue, identified with my mentor, was the completion of CIWAs after a recurrence of use of alcohol.  CIWA stands for Clinical Institute Withdrawal Assessment. It is a scored assessment of both objective and subjective symptoms, with numerical values assigned based on the presence and severity of symptoms (Sullivan et al., 2018). If a patient scores mildly enough that no medication is required, the patient can continue to be monitored without the need for medication for withdrawals. If the CIWA score is high enough, the patient needs medical attention.

The measurable problem in my agency is the completion of CIWAs after a recurrence of use, in a timely and consistent manner. There are occasions when the care coordinator may not know a recurrence has occurred immediately due to communication issues between the client and team members, or even between the team members themselves.

How this problem was chosen with my mentor was a directed discussion about this class and about choosing a quality measure that could use improvement, prior to this class even starting. This was chosen because it is a measurable quality issue that affects patient safety. It is also an issue that can be addressed proactively. The early detection of alcohol withdrawal is important to avoid the medical dangers associated with withdrawal (Ismail et al. 2019, Koh et al, 2021), as well as potential behavioral changes caused by alcohol withdrawal (Bradenu et al.,2019). By developing a plan for quicker and consistent assessment of alcohol withdrawal symptoms, our patients will be safer.

 

 

 

 

References

Bradeanu, A., Pascu, L., Ungurianu, S., Tutunaru, D., Rebegea, L., Terpan, M., & Ciubara, A. (2019). The Effect of Behaviour in Patients Who Are Hospitalized and Suffer from Alcohol Withdrawal. BRAIN: Broad Research in Artificial Intelligence & Neuroscience, 10, 46–51.

Ismail, M. F., Doherty, K., Bradshaw, P., O’Sullivan, I., & Cassidy, E. M. (2019). Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit. Emergency Medicine Journal, 36(1), 18–21. https://doi.org/10.1136/emermed-2017-206997

Koh, J. J.-K., Malczewska, M., Doyle-Waters, M. M., & Moe, J. (2021). Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review. BMC Emergency Medicine, 21(1), 131. https://doi.org/10.1186/s12873-021-00524-1

 

Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., Sellers, E. M., Mayhugh, R. E., Rejeski, W. J., Petrie, M. R., Laurienti, P. J., & Gauvin, L. (2018). Revised Clinical Institute Withdrawal Assessment for Alcohol Scale. PLoS ONE, 13(4), 1–15.

RESPONSE 2

N. Galloway 

RE: Group A Practice Experience Discussion – Week 1

COLLAPSE

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The patient-centered practice problem related to safety that I am choosing for my capstone project is the need for ligature cutters in my employer’s psychiatric unit, which is referred to as the 5P unit. Over 1,500 suicides occur each year in psychiatric hospital units in the United States. Over 70% of those are by hanging (Mills, para. 1, 2013). This makes it the most common suicide method in the inpatient Department of Veteran’s Affairs (VA) psych units (Mills, para. 3, 2013). Environmental risk assessments are always performed, and this local unit has been equipped with anti-ligature hardware such as door handles, shower heads, furniture, sinks, and toilets. Careful consideration is also taken when giving patients clothes to wear. All the strings of the sweatpants are removed, and all bedding is tear-resistant. If patients are deemed a high suicide risk, they are required to wear a safety smock, which is a tear-resistant single piece of clothing (Health Products for You, n.d.). However, sometimes those interventions fail, and the patient finds a way to create a ligature. It is also difficult to eliminate suicidal risk on mental health units because the safety interventions are not always 100% effective. There is also a fragile balance between keeping everyone safe and maintaining an environment that is humane, welcoming, and promotes healing (Mills, para. 19, 2-13).

 For example, one of my supervisors told me a story about a patient on our unit who was admitted for suicidal ideation. One night he took his pants off under his sheet in the middle of the night and tied them around his neck. The unit did not have a safe and quick way to cut the pants from around his neck. Although the nursing staff eventually removed the ligature and the patient was not harmed, this event alerted the unit that they did not have any type of ligature cutters that are often found on other psych units to prevent these types of occurrences.

Having an efficient and safe method to remove a ligature from a patient’s neck is just as important as all of the other safety measures found in a typical psych unit. If the person survives the initial event, he or she may later die due to the initial hypoxic and ischemic brain damage (Kodikara, 2012). The brain can only survive without oxygen for three to six minutes before permanent brain damage occurs. However, this does vary from person to person and from case to case (Spinalcord.com Team, 2020). After analysis of the previously stated statistics, the VA has implemented several interventions and has seen an approximately 82% decrease in attempted and completed suicides (Richman, 2021). Not all VA hospitals have the same equipment. I would like to obtain ligature cutters for our VA psych unit so that we can continue to maintain patient safety even during emergency events.

 

References

Health Products For You. (n.d.) Humane Restraint Suicide Prevention Safety Smock. https://www.healthproductsforyou.com/p-humane-restraint-suicide-prevention-safety-smock.html

Kodikara S. (2012). Attempted suicidal hanging: an uncomplicated recovery. The American journal of forensic medicine and pathology, 33(4), 317–318. https://doi.org/10.1097/PAF.0b013e3182443585

Spinalcorld.com Team. (2020). How Long Can the Brain Go Without Oxygen? What Happens? https://www.spinalcord.com/blog/what-happens-to-the-brain-after-a-lack-of-oxygen

Mills, P. D., King, L. A., Watts, B. V., & Hemphill, R. R. (2013). Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: avoiding environmental hazards. General hospital psychiatry, 35(5), 528–536. https://doi.org/10.1016/j.genhosppsych.2013.03.021

Richman, M. (2021). VA hospital improvises with new device to prevent in-patient suicides. https://www.research.va.gov/currents/0421-VA-hospital-improvises-with-new-device-to-prevent-in-patient-suicides.cfm

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