Substance abuse is an insidious public health problem in the United States. It’s costs to society are measured in both billions of dollars and thousands of lives lost.
It also directly affects physicians, who frequently find themselves on the front lines of the battle against drug and alcohol abuse.
According to the National Institute on Drug Abuse, the health care costs of alcohol and illicit drugs totals more than $35 billion annually. The Centers for Medicare & Medicaid Services reports that more than 45,000 people die from drug overdoses each year and another 29,000 deaths are alcohol induced.
Many of these people present to emergency departments and appointments while they are under the influence.
Patients with substance abuse problems and are under the influence are particularly vexing for physicians. They raise questions related to informed consent, standards of care, and the safety and security of hospital staff as well as other patients.
Here is a look at how to effectively manage patients that are under the influence:
Address Safety Issues
Patients who are under the influence have been known to spit, punch and kick physicians, nurses, staff and even other patients. They can be belligerent, noisy and difficult to assess. Their mere presence can elevate the stress level of everyone in the hospital or clinic.
The first thing you should do when a patient appears to be under the influence is take steps to keep yourself, your staff and other patients safe.
Because most healthcare professionals will rightfully feel obligated to try to at least assess the patient’s condition, steps should be taken to do this as safely as possible. Separating the patient may be an option. However, it may be necessary to call security or local law enforcement if the patient refuses to cooperate and continues to be disruptive.
In cases where treating the patient is absolutely necessary, it may be appropriate to restrain the patient physically or with medication.
Reschedule, if Possible
Generally speaking, patients who are under the influence of drugs or alcohol should have their appointments rescheduled if their condition is stable. Rescheduling is not always an option, and should be the course of action only after an appropriate assessment has been completed.
Rescheduling reduces your liability, helps protect your staff and ensures that any treatments are properly prescribed. It also provides an opportunity for you to educate the patient about the impact substance abuse has on their health–as well as your ability to provide care.
Of course, if the patient is in the throes of an acute medical situation, you should follow the practices outlined in your organization’s standard of care policy.
Discuss and Document
To determine whether or not an appointment can be rescheduled, it will be necessary to discuss the situation with your patient. Document the current situation and any history of substance abuse. Make sure to take into consideration the patient’s ability to provide accurate information.
Discussing the situation with your patient and documenting the interaction will both help you determine the best course of action and protect yourself from future lawsuits or claims of malpractice. Be sure to include patient comments–even quotes–in your notes as well as advice, instructions and any non-compliance.
Advise and Instruct
Physicians have a duty to provide appropriate discharge instructions. In a case of a patient who is under the influence, these instructions should include addressing transportation needs. If you feel the patient should not drive home, it’s critically important to make this clear–and arrange an alternative form of transportation for the patient.
Dealing with patients of all kinds can be very stressful, and that’s why Elliot Health System promotes a healthy work-life balance. Consider some of the options in this guide if you need to take some time for yourself.
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