POLICY STATEMENT
CLINICAL & OPERATIONAL MANAGEMENT OF
SUBSTANCE MISUSERS
SH Associated Centres (SHAC) Treatment Strategy Team is committed to supply the Seagrave Healthcare Network (SHN) centres, state of the art protocols, guidelines and new developments in the field in order to improve all treatments and supported throughcare of SHN patients. This work is carried out by a Multi-Disciplinary Team lead by the clinical management of SH.
CLINICAL & OPERATIONAL MANAGEMENT OF
SUBSTANCE MISUSERS
This policy exists to ensure that both the clinical and treatment strategy services for the assessment, treatment and care of patients with addictive behavioural problems are delivered in a comprehensive and holistic manner.
The Treatment Strategy Service in conjunction with each SHAC will play a key role in the development of the Seagrave Healthcare Treatment Strategy through a consultative process with the NHS and other local, regional or national drug and health agencies, monitoring and evaluating clinical activity, supportive interventions & therapies and advising and shaping policy and practice through the use of a fully multi-disciplinary team and membership on the relevant clinical committees.
WORKING PROTOCOL
1. All patients on arrival at any SHAC will undergo a comprehensive assessment (including physical assessment).
2. Specialized staff will interview and examine all new patients and will note any clinical features of dependency and any unrelated existing medical conditions, or withdrawal. Any history of ongoing treatment, co existing mental disorders, or agency support will be checked prior to the commencement of detoxification or prevention strategy whenever possible, and the next day in all other cases. An entry will be made in the patient’s medical record identifying him as drug/alcohol/substance dependent patient.
3. All patients identified as being a drug user will provide two positive urine/ saliva tests before treatment will be commenced.
4. Urine tests will be required to identify all drugs used i.e. Opiates, Benzodiazepines, Methadone, Cocaine, Amphetamines or Cannabis. Urine tests will be medically confidential and results will be recorded in the client Medical Record, clearly marking the types of drugs used (heroin/methodone/cocaine/crack/amphetamines/benzodiapines/cannabis) to correctly assess the patient for a detoxification or maintenance regime.
5. If it is clinically indicated, (and patient meets admission requirements of Switch project, defined in Switch project policy and procedure document ) the patient will be admitted for clinical treatment by Seagrave Healthcare.
6. The doctor, nurse or drug worker will enquire about possible HIV or Hepatitis infection (Or other blood-borne viruses.)
7. Where clinically indicated, investigations will include:
• FBC
• Urea/Electrolytes/LFT (including Gamma GT)
• Screening for Hepatitis B and C and HIV will be referred to the local GUM clinic
9. Care of the patient will be as directed by the responsible Doctor in consultation with the Nursing and Switch team.
10. All treatment and plans for patient throughcare will be fully documented in the Client Medical Record.
11. Treatment will be agreed with the patient and other professionals, who may include the family, or other third parties involved with the appropriate patient’s consent. A joint disclaimer will be signed by the patient to this effect and filed in the Switch treatment files
12. SHAC must contact the appropriate agency, when a patient is already on a treatment programme.
13. As part of the patients follow up plan, the appropriate staff will monitor and review the on-going health of the patient in line with the detoxification protocols for the medication prescribed; ensuring that the dose is compliant with patient’s assessed needs. The Physical and Mental Health of the patient will be monitored and reviewed at least every month. If clinical consultation/review of the patient is required a referral will be made to the appropriate consultant. This work will be undertaken regardless of the patient’s drug problem.
14. All SHACs will undertake Health Promotion Work. Advice will be given on Harm reduction, Hepatitis B/C (& vaccination), loss of tolerance and risk of overdose. On-going assessment of motivation will be undertaken and contribution made to the counsellors or therapists casework record. This work can be achieved through individual consultation or as part of the group work setting in the Centre.
15. The Doctor must make clear records of patient prescriptions in line with the Misuse of Drugs Act.
16. Nurses and Health Care Workers will administer and record drugs safely in accordance with the Nursing & Midwifery Council Policy.
The Treatment Strategy Service in conjunction with each SHAC will play a key role in the development of the Seagrave Healthcare Treatment Strategy through a consultative process with the NHS and other local, regional or national drug and health agencies, monitoring and evaluating clinical activity, supportive interventions & therapies and advising and shaping policy and practice through the use of a fully multi-disciplinary team and membership on the relevant clinical committees.
WORKING PROTOCOL
1. All patients on arrival at any SHAC will undergo a comprehensive assessment (including physical assessment).
2. Specialized staff will interview and examine all new patients and will note any clinical features of dependency and any unrelated existing medical conditions, or withdrawal. Any history of ongoing treatment, co existing mental disorders, or agency support will be checked prior to the commencement of detoxification or prevention strategy whenever possible, and the next day in all other cases. An entry will be made in the patient’s medical record identifying him as drug/alcohol/substance dependent patient.
3. All patients identified as being a drug user will provide two positive urine/ saliva tests before treatment will be commenced.
4. Urine tests will be required to identify all drugs used i.e. Opiates, Benzodiazepines, Methadone, Cocaine, Amphetamines or Cannabis. Urine tests will be medically confidential and results will be recorded in the client Medical Record, clearly marking the types of drugs used (heroin/methodone/cocaine/crack/amphetamines/benzodiapines/cannabis) to correctly assess the patient for a detoxification or maintenance regime.
5. If it is clinically indicated, (and patient meets admission requirements of Switch project, defined in Switch project policy and procedure document ) the patient will be admitted for clinical treatment by Seagrave Healthcare.
6. The doctor, nurse or drug worker will enquire about possible HIV or Hepatitis infection (Or other blood-borne viruses.)
7. Where clinically indicated, investigations will include:
• FBC
• Urea/Electrolytes/LFT (including Gamma GT)
• Screening for Hepatitis B and C and HIV will be referred to the local GUM clinic
9. Care of the patient will be as directed by the responsible Doctor in consultation with the Nursing and Switch team.
10. All treatment and plans for patient throughcare will be fully documented in the Client Medical Record.
11. Treatment will be agreed with the patient and other professionals, who may include the family, or other third parties involved with the appropriate patient’s consent. A joint disclaimer will be signed by the patient to this effect and filed in the Switch treatment files
12. SHAC must contact the appropriate agency, when a patient is already on a treatment programme.
13. As part of the patients follow up plan, the appropriate staff will monitor and review the on-going health of the patient in line with the detoxification protocols for the medication prescribed; ensuring that the dose is compliant with patient’s assessed needs. The Physical and Mental Health of the patient will be monitored and reviewed at least every month. If clinical consultation/review of the patient is required a referral will be made to the appropriate consultant. This work will be undertaken regardless of the patient’s drug problem.
14. All SHACs will undertake Health Promotion Work. Advice will be given on Harm reduction, Hepatitis B/C (& vaccination), loss of tolerance and risk of overdose. On-going assessment of motivation will be undertaken and contribution made to the counsellors or therapists casework record. This work can be achieved through individual consultation or as part of the group work setting in the Centre.
15. The Doctor must make clear records of patient prescriptions in line with the Misuse of Drugs Act.
16. Nurses and Health Care Workers will administer and record drugs safely in accordance with the Nursing & Midwifery Council Policy.