Drug Abuse Warning Network (DAWN)

Transcription

1 Psychiatric Advanced Practice Registered Nurse Role in Alcohol and Substance Abuse Evaluation in the Emergency Department: DAWN-ing of a New Day Vanessa Genung PhD, RN, F/PMH-NP, LCSW-ACP, LMFT, LCDC Gina M. White, MSN, RN Vicki Moceo, MSN, RN The speakers have no conflicts of interest to disclose. Drug Abuse Warning Network (DAWN) What is DAWN? Network 250 hospitals What is the function of DAWN? Provides data on drug-related emergency department (ED) visits to Substance Abuse and Mental Health Services Administration (SAMHSA) Who uses DAWN? Federal agencies, Communities, Member hospitals, Pharmaceutical industry How is the DAWN data used? Plan, develop, obtain and improve policy, programs, grants, care Key Facts: Substance Abuse & Mental Health Cost of substance abuse in US $510.8 billion Mental health issues will pass physical disease by 2020 Estimated 9.8 million 18 & older had serious mental illness in 2008 Estimated 2 million persons age had major depressive episode in past year Estimated 23.5 million children age 12 & older needed treatment for substance abuse 1/2 of all mental & substance abuse begins by age 14, ¾ by age 24 Genung, White, Moceo 1

2 Demographics of Drug User in US 47.9% White, 29.7% Black, 10.9 Hispanic, 1.1% Other Rates higher for Males than Females in all categories Ages12-17 high rates alcohol/drug -13.0% Ages high rates alcohol alone 11.0% Ages highest rates for marijuana Ages highest rates for heroin Ages highest rates for cocaine Roles and Responsibility of the PMH-APRN in the ED Utilize DAWN demographics to identify potential users Utilize DAWN Statistics to identify trending drugs Recognize signs & symptoms of intoxication & withdrawal Assess rapidly with standardized drug & alcohol screens Manage with standard clinical regimens Refer for specialized drug & alcohol evaluation or treatment Clinical Assessment History, chief complaint Physical examination CAGE Acronym for Cutting down, Annoyance by criticism, Guilty feeling, Eye-openers Four question interview Screens for alcohol use can be adapted for other drugs Genung, White, Moceo 2

3 Clinical Assessment MAST(Michigan Alcohol Screening Test) Screens for alcohol abuse Interview or self administration TWEAK Acronym for Tolerance, Worried, Eye-opener, Amnesia, Cut down Alcohol screening test, originally designed to screen pregnant women Clinical Presentation: Depressants Intoxication Loss of coordination Slurred speech, glazed eyes, constricted pupils Flaccid appearance Decreased vital signs Memory loss, nausea, vomiting Semi-conscious Alcohol, Opioids, Benzodiazepines, Morphine, Heroin, Marijuana Withdrawal Anxiety, sweating Nausea, irritability, muscle pain Increased vital signs Generalized tremors Seizures, hallucinations Delirium, death Clinical Presentation: Stimulants Intoxication Dilated pupils, increased vital signs Lip smacking, dry nares, nosebleeds Anorexia, insomnia, Anxiety, rapid speech and thought process Paranoia, psychosis Withdrawal Craving, generalized malaise, restlessness Irritability, lack of pleasure, suspicious Agitation, anxiety Vivid/unpleasant dreams Extreme depression, suicide Cocaine, Methylphenidate, Amphetamines Genung, White, Moceo 3

4 Clinical Presentation: Euphorics Intoxication Dilated pupils, increased vital signs Nausea, vomiting Blurred vision, poor coordination, amnesia Anxiety, paranoia, depression, ideas of reference Hallucinations, synesthesia depersonalization, illusions Ecstasy, GHB, LSD, PCP Craving Withdrawal No physical signs except with PCP (violence, muscle rigidity, convulsions, coma) Dual Diagnosis Co-occurring: Psychiatric diagnosis and Substance Abuse Substance Abuse diagnosis which may include both alcohol and drugs Diagnosing and treating more difficult Patient history is important Treatment of symptomology Laboratory Tests Blood Alcohol Level Urine Drug Screen Toxicology Screen Complete Blood Count, Urinalysis i Comprehensive Metabolic Panel Acetaminophen/ASA Genung, White, Moceo 4

5 Clinical Management Fluids, banana bag Symptomatic treatment Depressants Chlordiazepoxide, diazepam, lorazepam Clonidine, naloxone, flumazenil Stimulants Benzodiazepines, diazepam, antipsychotics Euphorics Benzodiazepines, charcoal (for PCP) Clinical Implications for PMH-APRN in ED 118 million visits were made to the ED in US million of the visits were associated with drug use Number of ED visits from 2004 to 2008 for drug use has increased by over 70% The APRN is able to recognize, assess, evaluate, treat, and refer the patient with substance issues The APRN is prepared to lead a triage team for the emergent substance intoxication or withdrawal event EDs are sites to intercept patients for follow-up treatments for drug use PMH-APRN Networks with Referrals Medical or psychiatric inpatient admission Community mental health centers-outpatient assessment and treatment Individual/Group counseling, Psychotherapy, Cognitive Behavioral Therapy PMHNP/CNS, LCSW-ACP, LPC, LMFT, LCDC PMH Nurse Practitioner/Clinical Nurse Specialist Licensed Clinical Social Worker-Advanced Clinical Practitioner Licensed Professional Counselor Licensed Psychologist Licensed Marriage and Family Therapist Licensed Chemical Dependency Counselor Outpatient Medication Management and Rehab PMH Nurse Practitioner/Clinical Nurse Specialist Psychiatrist Licensed Psychologist (in some states) Self-help groups such as Alcoholics Anonymous or Narcotics Anonymous Outpatient Rehab treatment programs Genung, White, Moceo 5

6 Implications for Public Health DAWN assists Federal agencies: Food and Drug Administration, Centers for Disease Control, White House Office of National and Drug Control Policy, and Substance Abuse and Mental Health Services Administration DAWN helps these agencies: Assess abuse potential of drugs, assist in scheduling and labeling controlled substances, identify adverse reactions, assess progress and pinpoint problems in controlling drug abuse, track changing patterns of drug use Implications for Public Health DAWN helps communities: Obtain information on potential public health problems such as, underage drinking, adverse reactions to medications in the elderly, accidental poisonings in young children, misuse of prescription drugs Assists local communities to assess need for public health resources and detect emerging drug problems and trends Implications for Public Health DAWN helps local hospitals: Educate providers and communities about drug problems Assist hospital managers in allocating resources and staff DAWN helps pharmaceutical industry: Track use, misuse, and abuse of their products A PMH-APRN in the hosp ED is research informed and clinically ready to be a bridge between the medical and the psychiatric; between the SAMHSA DAWN and the ED of a hospital; and between the patient s illness and their wellness. It is the DAWN-ing of a new day Genung, White, Moceo 6