Perinatal, Neonatal, Pediatric Conference Presented By: Cheryl - PowerPoint PPT Presentation

Perinatal, Neonatal, Pediatric Conference Presented By: Cheryl Piper, R.N., CADC Vice-President of Clinical Services Remedies Renewing Lives

Objectives  Learn about drug trends in Illinois/Winnebago County  Identify Symptoms of Substance use Disorders  Recognize the impact of addiction on our Nursing practice  Identify strategies to work with chemically dependent pain patients

Drug Trends in Illinois  Drug arrests are above national average (828 arrests per 100,000 vs. average 620 arrests per 100,000 in other states)  Alcohol and Marijuana are the most abused drugs (68%)  Cocaine is making a big comeback (Up from 35% to 40%)  Opiates are the fastest growing drug of abuse (48%)  Hallucinogens are losing popularity (K2, Molly, Methamphetamines) Down from 18% to less than 10%

Drug Trends in Illinois (continued) • Pregnant/childbearing age female admissions to Illinois treatment facilities have increased from 32% to 46.5 % over the past five years • Approximately 3 of every 1,000 babies born in Illinois have experienced neonatal abstinence • Non-medical use of prescription opiates/heroin addiction is admitting diagnoses for 55% of treatment admissions •

Drug Trends in Illinois (continued) • Illinois rates for non-medical use of pain meds runs at 5.3 % of population (highest range is 7.2 % in Western States)

Barriers to “Treatment for Pregnant/Parenting Females • Treatment costs/availability of appropriate services. • Shame and guilt “How could I do this to my baby, my family?” “What will my caregivers think of me?” • Fearful of withdrawal • Fearful of potential loss of child (children) custody.

Barriers to Treatment for Pregnant/Parenting Females continued • Need for child care for their current children if hospitalized for treatment.

Addiction Impact on Health Care  10-15% of the general population are chemically dependent  National studies indicate that between 20-40% of all acute care hospitalizations are alcohol/drug related  Over 3,000 patient ED visits recorded in two of the three Rockford hospitals r/t opiate withdrawal/overdose in 2017  Rockford Fire Department reports ‘911’ calls for overdose

Addiction Impact on Health Care • Rockford Fire Department reports ‘911’ calls for overdose victims a minimum of 4 calls daily. • Winnebago County Coroner reports 124 overdose deaths in Winnebago County for 2017. Over 40% were female.

Symptoms of Addiction Early Stage • Occasional relief drinking/drug use • Urgency of first drink/use Crucial Phase • Feelings of guilt- “not normal use” • Increase in alcohol/drug tolerance •Onset of memory “blackouts” Falling out • Grandiose/aggressive behaviors • Efforts of control fail Chronic Phase • Life difficulties related to social, financial, • Decrease of alcohol/drug tolerance vocational, scholastic, legal, and health • Significant physical/psychological deterioration

Screening Tool CAGE C---------------- Have you ever tried to Cut down on your use? A---------------- Do you get Annoyed when people talk about your drinking/drug use? G---------------- Do you feel Guilty about your drinking/drug use? E---------------- Have you ever had an Eye-Opener? (Drinking or using the morning after)

Narcotic Withdrawal Symptoms  Drug cravings/Anxiety  Yawning, sweating, lacrimination, rhinorhea  Gooseflesh, muscle twitching  Insomnia, abdominal cramping, vomiting, diarrhea

Detox Protocols  Clonidine 0.1 mg-0.2 mgs. every 4-6 hours for anxiety PRN  Zofran PO or Tigan 200 mgs. IM or every 6 hours for nausea PRN  Ibuprofen 600 mgs. every 6 hours for aching PRN  Bentyl 20 mgs. every four hours for abd. Cramping PRN  Buprenorphine 8/2mgs. (five day taper) MUST be in active withdrawal before administering.  Methadone Taper is done very slowly (Usually 2-5 mgs. Every 5-7 days)

Treatment of the Identified Addicted Patient  Explain use of opiates  Validate Patient’s fear of relapse  Offer support and reinforce that mediation is being utilized for a medical condition  Respect Patient’s right to be involved in decision -making process and refusal of opiates  Involve support system  Explore alternative methods of pain management  Important to remember that methadone maintenance patients will require additional pain medication beyond their daily dose

Treatment of the Unidentified Addicted Patient  Monitor for Possible withdrawal symptoms  Avoid mood altering drugs that do not relieve pain  Identify appropriate staff as resources: Addiction and Pain  Specialists, one MD for prescribing opiates, Primary Nurses to coordinate care  Arrange regular staff meetings to plan care and “vent”  Examine own attitudes/Do not allow a negative impact on patient care  Acknowledge Limitations  Pain cannot be proven  Addiction treatment is not possible while patient is in “acute” pain  Patient may not admit addictive disease

Establish Appropriate Goals • Monitor/medicate for withdrawal symptoms • Identify pain ratings acceptable to patient and side effects that are unacceptable • Dose until patient reports satisfactory pain relief • Avoid excessive negotiation with patient regarding pain medications

Reduce Problematic Behaviors · Be specific with expectations · Be consistent with pain relief · Avoid “rescuing behaviors” · Consider “contracting” with the patient · Make a plan for withdrawal · Give information on chemical dependency treatment services

Pain Contract • Goals for Pain Management: • 1. To make me as comfortable as possible during the acute pain phase. • 2. Relieve my pain without sedation. • 3. To control my withdrawal symptoms. • Contract Terms: • 1. The nursing staff agrees to accept and respect my reports of pain as the best indicator of how much pain I am experiencing. • 2. I may receive as much analgesia as I need to relieve pain unless the dose would put me at risk for complications. • 3. I will not tamper with the PCA equipment and, if I do, the PCA will be stopped. • 4. My other medications will be given on time. • 5. The medication used to manage my pain will be reduced gradually as I progress through my recover. • I have discussed and agree with the terms of this contract.

Summary of Treatment Strategies  Acknowledgement of recovering addicts fears---RELAPSE  Honor patient’s involvement in pain management process  Provide additional support through involvement of 12 Step Sponsor, addiction counselors and or family  Remember unrelieved pain can itself be a trigger  For patients not in recovery, establish realistic goals for pain management and adhere to those goals  You can lay the groundwork for a trusting relationship that can facilitate drug treatment