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Address comorbid problems collaboratively

May 1, 2008
by Bernadette Solounias, MD
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All program employees, from admissions staff to drivers, can inform comprehensive treatment planning

We know that addiction to alcohol and/or drugs carries the risk of multiple medical, psychiatric, and behavioral comorbidities that are often neglected, undertreated, or overtreated. The presence of toxins in the body alters physiological functions that have an impact on such factors as blood pressure, pain control, memory, emotional state, liver function, and immunity. The transition from an intoxicated state to a drug- and alcohol-free state is a time of stress, both physically and emotionally. In early recovery, there is the potential for calamity—either medical, emotional, social, or all combined. A team approach to treatment that marries the talents and input of medical, clinical, spiritual, and programmatic professionals, relying on collaboration at every level, can be a major contributor to success.

At Father Martin's Ashley, we have worked diligently to create and grow a pa-tient model of care that has collaboration at its core. Long-term staff have honed their communication skills and refined their approaches to include consultation with other disciplines, ensuring 360-degree patient observation and documentation and creating a culture of shared responsibility for patient success. New employees are trained in the collaborative processes, and all are encouraged to provide suggestions so processes may improve over time because of better ideas, the introduction of technology, modifications in work space, changes in regulations, or responses to patient, family, and referring partner input.

All departments involved in patient care are required to communicate with one another. This communication starts before admission with the initial information-gathering process and continues throughout the patient's stay and on to aftercare. All relevant patient information is captured and shared through a variety of mechanisms.

As staff members observe patients in different settings and interactions, these observations are shared in the confidential patient electronic file, at daily team meetings, or both. We have found it critical for these multiple observations to be shared, especially if a patient is struggling.

First contact

We believe that matching potential patients with the programs that best suit their needs is the key goal in the admissions process. A thorough assessment of the potential patient's medical and psychological status is imperative. We often ask referring professionals to help provide a complete medical/psychological history so we can structure a treatment program tailored to the patient's specific needs. In some cases, we recommend that the patient seek treatment in a different program, such as a psychiatric facility, if his/her condition warrants.

Since medical or emotional problems can interfere with a patient's participation in some treatment programs, the information gathered in this critical first assessment becomes the backbone of the shared patient treatment data file. Our admissions staff often consults with me, our other full-time physician (Howard Williams, MD), or our director of nursing (Charlotte Meck, RN) to ensure that any co-occurring issues are within our scope of service. This pre-admission collaboration minimizes situations in which arriving patients are too sick to participate successfully in programs.

For the admissions staff to be able to conduct effective screenings, they are trained to ask about medical and psychiatric problems and medications. Our physician and nursing staffs regularly update our admissions counselors and are available for immediate consultation. Admissions staff members work with a comprehensive list of questions and follow-up inquiries to gain a complete understanding of the prospective patient's health and family situation. For example, if an individual inquiring about treatment reports that he/she has been treated for bipolar disorder, a series of follow-up questions assesses current status. If an individual, family member, or referring professional reports that the patient is experiencing weakness or falls, the admissions staff knows what questions to ask about ambulation and ability to engage in activities of daily living.

We have found that it is critical for admissions staff to be aware of the drugs of abuse and their common names, as well as the names of medications. Staff members have been instructed by the physician staff about certain medications or multiple medications that raise red flags for further assessment or consultations from medical staff in the assessment process.

Individuals who are in the hospital or who have complicated medical or psychiatric histories may require a more thorough screening. It is not unusual for the admissions staff to request hospital records for the staff physician to review, or to ask the potential patient's physician to contact our physician so that a decision about the patient's ability to participate in the treatment program can be assessed. There are times when our nursing staff will contact the nurses caring for a hospitalized patient to get a nursing report so that we can accurately assess the individual's functioning, or the nurse may speak with the patient directly.

Case examples

A case overview for “Frank” presents a good example of how early collaborative assessment can lead to appropriate timing for addiction inpatient admission, as well as define the important continuum of care for co-occurring issues.