Cart
Courses: 0

Total: $00.00

Detox Protocol Training 20-580358 2 hours Back to Course Index

 

 

 

protocol2

 

 

A medical protocol is a compilation of the successful actions of medical practitioners, and allows one to achieve the same success on patients by following the steps of the medical protocol.  It is norm or standard accepted by the community of practitioners in that speciality.

Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal. It denotes a clearing of toxins from the body of the patient who is acutely intoxicated and/or dependent on substances of abuse. Detoxification seeks to minimize the physical harm caused by the abuse of substances. untitled-2

Each facility may create their own specific detox protocol, however they should follow the norms of the protocols accepted to be best practices as well as keeping in line with Florida statutes for patient’s rights.

Detoxification, in and of itself, does not constitute complete substance abuse treatment. The detoxification process consists of three essential components, which should be available to all people seeking treatment:

•Evaluation

•Stabilization

•Fostering patient readiness for and entry into substance abuse treatment

Detoxification can take place in a wide variety of settings and at a number of levels of intensity within these settings. Placement should be appropriate to the patient’s needs.

All persons requiring treatment for substance use disorders should receive treatment of the same quality and appropriate thoroughness and should be put into contact with substance abuse treatment providers after detoxification.

Ultimately, insurance coverage for the full range of detoxification services should be cost-effective.

Patients seeking detoxification services have diverse cultural and ethnic backgrounds as well as unique health needs and life situations. Programs offering detoxification should be equipped to tailor treatment to their client populations.

A successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters and remains in some form of substance abuse treatment/rehabilitation after detoxification.

 

SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES

Florida law requires that a health care provider or health care facility recognize an individual’s rights while they are receiving medical care and that professional’s respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. A patient may request a copy of the full text of this law from a health care provider or health care facility. A summary of the patient’s rights and responsibilities follows:

  • A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
  • A patient has the right to a prompt and reasonable response to questions and requests.
  • A patient has the right to know who is providing medical services and who is responsible for his or her care.
  • A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
  • A patient has the right to know what rules and regulations apply to his or her conduct.
  • A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
  • A patient has the right to refuse any treatment, except as otherwise provided by law.
  • A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
  • A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment; whether the health care provider or healthcare facility accepts the Medicare assignment rate.
  • A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
  • A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
  • A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
  • A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
  • A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
  • A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
  • A patient is responsible for providing to the healthcare provider, to the best of his or her knowledge, accurate and complete information about resent complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
  • A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
  • A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
  • A patient is responsible for following the treatment plan recommended by the health care provider.
  • A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or healthcare facility.
  • A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
  • A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as
  • A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.

 

PROGRAM POLOCIES

Detoxification is only one component in the continuum of healthcare services for substance-related disorders. There is a critical need for non-traditional settings—emergency rooms, medical and surgical wards in hospitals, acute care clinics, and others—to be prepared to participate in the process of getting the patient who is in need of detoxification services into treatment as quickly as possible. Furthermore, it promotes the latest strategies for retaining individuals in detoxification while also encouraging the development of the therapeutic alliance to promote the patient’s entrance into substance abuse treatment.

Programs should be addressing psychosocial issues that may impact detoxification treatment, such as providing culturally appropriate services to the patient population.

Matching patients to appropriate care represents a challenge to detoxification programs. Given the wide variety of settings and the unique needs of the individual patient, establishing criteria that take into account all the possible needs of patients receiving detoxification and treatment services is an extraordinarily complex task.

Placement will depend in part on the substance of abuse. Generally for alcohol, sedative-hypnotic, and opioid withdrawal syndromes, hospitalization or some form of 24-hour medical care is often the preferred setting for detoxification, based on principles of safety and humanitarian concerns.

A further challenge for detoxification programs is to provide effective linkages to substance abuse treatment services. Patients often leave detoxification without followup to the treatment needed to achieve long-term abstinence. 

 

HIPAA NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about a patient may be used.  State and federal laws allow recovery facilities to use and disclose health information for the following purposes.

TREATMENT: A provider may need to use or disclose health information to provide, manage or coordinate care or related services which could include consultants and potential referral   sources.

PAYMENT: Information needed to verify insurance coverage and/or benefits with an insurance carrier, to process claims as well as information needed for billing and collection purposes. A provider may bill the person in the patient’s family who pays for the insurance.

HEALTHCARE OPERATIONS: A provider may need to use information about a patient to review their treatment procedures and business activity. Information maybe used for certification, compliance and licensing activities.

There are some instances where a provider may be required to use and disclose information without a patient’s consent. For example, but not limited to: information about physical or sexual abuse of a child: then by Florida State Law, a provider is obligated to report this to the Department of Children and Family Services, if a patient provides information regarding the danger of a patient harming himself or herself or others, information to remind of/or to reschedule appointments or treatment alternatives or information shared with law enforcement if a crime is committed on facility premises or against the staff or as required by law such as a subpoena or court order.

 

CONFIDENTIALITY

To reinforce the feelings of closeness and willingness to share with others the patient’s feelings, thoughts and consequences of substance misuse and/or mental health difficulties confidentiality is a must in group therapy. “What is said in group stays in group”. If anyone in the group breaks this rule they violate the trust of the entire group and the effectiveness of the group process is lost.

The following guidelines will help everyone honor this rule:

  1. Group issues are not discussed with others outside of the group.
  1. Do not discuss group issues with roommates unless he/she is in the group.
  1. Do not discuss at any outside meetings or places where others may overhear.

The group therapists have the same responsibilities for group confidentiality, with the exception that the therapists share group issues and participation in the group process with other staff members. This is a vital part of the multidisciplinary team approach which is designed to assist in recovery. Protecting confidentiality is an ethical duty of the provider.

 

TREATMENT

Detoxification, in and of itself, does not constitute complete substance abuse treatment. The detoxification process consists of three essential components, which should be available to all people seeking treatment:

•Evaluation

•Stabilization

•Fostering patient readiness for and entry into substance abuse treatment

Detoxification can take place in a wide variety of settings and at a number of levels of intensity within these settings. Placement should be appropriate to the patient’s needs. All persons requiring treatment for substance use disorders should receive treatment of the same quality and appropriate thoroughness and should be put into contact with substance abuse treatment providers after detoxification.

Patients seeking detoxification services have diverse cultural and ethnic backgrounds as well as unique health needs and life situations. Programs offering detoxification should be equipped to tailor treatment to their client populations.

A successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters and remains in some form of substance abuse treatment/rehabilitation after detoxification.

Addiction medicine has sought to develop an efficient system of care that matches patients’ clinical needs with the appropriate care setting in the least restrictive and most cost-effective manner.

The five “Adult Detoxification” placement levels—define the most broadly accepted standard of care for detoxification services. The five levels of care are:

1. Level I-D: Ambulatory Detoxification Without Extended Onsite Monitoring

2. Level II-D: Ambulatory Detoxification With Extended Onsite Monitoring

3. Level II.2-D: Clinically Managed Residential Detoxification

4. Level III.7-D: Medically Monitored Inpatient Detoxification

5. Level IV-D: Medically Managed Intensive Inpatient Detoxification ASAM criteria are being adopted extensively on the basis of their face validity, though their outcome validity has yet to be clinically proven.

 

The ASAM (the American Society of Addiction Medicine) guidelines are an important set of guidelines that are of great help to clinicians. For administrators, the standards published by such groups as the Joint Commission on Accreditation of Healthcare Organizations and the Commission on Accreditation of Rehabilitation Facilities provide guidance for overall program operations. Placement will depend in part on the substance of abuse. It is generally accepted that for alcohol, sedative-hypnotic, and opioid withdrawal syndromes, hospitalization (or some form of 24-hour medical care) is often the preferred setting for detoxification, based on principles of safety and humanitarian concerns. When hospitalization cannot be provided, then a setting that provides a high level of nursing and medical backup 24 hours a day, 7 days a week is desirable.

A further challenge for detoxification programs is to provide effective linkages to substance abuse treatment services. Patients often leave detoxification without follow up to the treatment needed to achieve long-term abstinence. Each year at least 300,000 patients with substance use disorders or acute intoxication obtain inpatient detoxification in general hospitals, while additional numbers obtain detoxification in other settings. Only 20 percent of people discharged from acute care hospitals receive substance abuse treatment during that hospitalization. Only 15 percent of people who are admitted to a detoxification program through an emergency room and then discharged go on to receive treatment.

A major clinical question for detoxification is the appropriateness of the use of medication in the management of an individual in withdrawal. This can be a difficult matter because protocols have not been firmly established through scientific studies or evidence-based methods. Furthermore, the course of withdrawal is unpredictable and currently available techniques of screening and assessment do not predict who will experience life-threatening complications.

Psychological dependence, co-occurring psychiatric and medical conditions, social supports, and environmental conditions critically influence the probability of successful and sustained abstinence from substances. Research indicates that addressing psychosocial issues during detoxification significantly increases the likelihood that the patient will experience a safe detoxification and go on to participate in substance abuse treatment. Staff members’ ability to respond to patients’ needs in a compassionate manner can make the difference between a return to substance abuse and the beginning of a new (and more positive) way of life.

 

DISCHARGE AGAINST MEDICAL ADVICE

Acutely psychotic, delusional, delirious, or demented patients or those with suicidal and homicidal ideation are not candidates for discharge against medical advice.  

For others, approach the patient calmly, explain with empathy what DAMA entails, and support the reasons for admission. Emphasize that following the treatment plan will alleviate psychiatric symptoms sooner and may shorten their stay.

Know the involuntary commitment procedures for your jurisdiction, and be prepared to discuss them with the patient. Assess the patient’s decision-making capacity, including awareness of the severity of his or her substance abuse or psychiatric illness and potential consequences of leaving against medical advice.

Arrange follow-up care for discharged against medical advice patients:

  • Provide the patient with a brief summary of diagnosis, medications, and follow-up plans.
  • Arrange the next available office or telephone appointment.
  • Obtain contact information of those responsible for the patient’s safety.
  • Provide the patient with emergency room and other phone numbers for crisis intervention.

Discharge against medical advice does not absolve the physician of responsibility for poor outcomes. Carefully document the discharge against medical advice process because these patients are at increased risk of harm.  Make sure the patient signs, dates, and notes the time on the discharge against medical advice request.

 

PATIENT GRIEVANCES

Emphasis on patient-centered care has increased.  Patient satisfaction is critical to positive outcomes. These trends in healthcare make seeking and responding to patient feedback increasingly important components of risk management and patient safety programs. Patients have the right to file complaints and grievances with the organization when they are unsatisfied with the treatment received, and healthcare organizations should have processes in place for handling both in a timely manner. In addition, tracking and trending of patient complaints and grievances may call attention to systems or individual performance problems and suggest quality improvement opportunities. For example, patient complaints are associated with both clinical complications and increased risk of malpractice litigation.

Healthcare organizations must develop processes for addressing patient complaints and grievances in order to comply with regulations and accreditation standards, as well as to protect patients and reduce liability. Complaints stem from minor issues that can typically be resolved by staff present at the time the concern is voiced, while grievances are more serious and generally require investigation into allegations regarding the quality of patient care. 

The Joint Commission and other accreditors’ complaint resolution standards also require that accredited facilities address and resolve complaints from patients and their families. 

Action Recommendations

  • Design a process to capture and address all complaints and grievances.
  • Ensure the involvement of the organization’s governing body or its designated grievance committee.
  • Implement policies, procedures, and processes for investigation and resolution of patient complaints and grievances.
  • Educate all staff on grievance processes.
  • Train all staff to listen effectively and manage patient and family expectations.
  • Use dedicated staff to solve small problems before they escalate.
  • Employ a proactive approach to customer service.
  • Empower frontline staff to act as the first line of defense against complaints.
  • Track complaints, grievances, and patient satisfaction surveys and implement improvement initiatives to address trends identified.
  • Verify that the grievance process is effective.

 

Thank you for using BaysideCEU.com!

We appreciate you!