Detox Units

unknown99, BSN, RN · Mar 28, 2004

We do not have a detox unit, but most of the time if a patient needs detoxed, they go to the ICU.

RNin92 · Mar 28, 2004

We do not have a detox unit, but most of the time if a patient needs detoxed, they go to the ICU.

Wow...bet those ICU nurses just LOVE that!!

Poor things!

:rolleyes:

missmercy · Mar 28, 2004

we didn't have adetox unit either -- just put them on the smaller of the med floors -- sure made for some interesting nights!!!

Long Term Care Columnist / Guide · Mar 28, 2004

Nope, we detox 'em right on the medical floor.....talk about your revolving door, we see some of the same people 2-3 times a month. They never get better.....we see them through several days of DTs, get beaten up, cursed at, kicked, etc. only to have them go straight out and do the same thing all over again. So depressing......and yet I always think, there but for the grace of God go I.

I remember one woman in particular who'd spend weeks in the hospital at a time coming off both ETOH and heroin. She was a HIV/Hep C positive pt. who'd try to bite us when we came near her, and it usually took her over a week just to get all the garbage out of her system. We rarely went more than a couple of months without seeing her; once she was in for almost a month, coded twice, and came out of her coma with permanent brain damage. Finally the day came for her to be discharged......and within 12 hours she was back, in the same miserable condition.

She finally passed away a couple of years ago, in the nursing home where I was the care manager at the time. She'd actually done well for a while after her last discharge from the hospital; she wasn't drinking or drugging, and she had resigned herself to the fact that she could no longer live on her own. I still don't know what catastrophe hit her; but one day, her usually pallid skin turned pumpkin-orange, and within hours she was gone. It was her 46th birthday. :crying2:

LoriRN911 · Mar 28, 2004

Hi all,

yea, we have a revolving door as well. Just when they finally "wake up" to some sort of level of life, they get mean, we d/c them and they're back within maybe 2-3 weeks (more or less). 72 hours isn't long enough for them to deox ( for the amount of time they're using) but when the insurance company is calling the shots you have to d/c them. I work on a dual diagnosis unit so I have the psych componment with the detox! OH BOY FUN!! I need a new speciality )) Maybe Burger King?? "Would you like fries with that burger??"

Trauma Columnist · Mar 28, 2004

We don't detox in the hospital - its a separate unit on the other side of town run by a contracted company that runs an inpatient addictions unit too. Works for us, but not well. Our ER still does the physicals for them before they can be accepted at detox.

Nurse Ratched, RN · Mar 28, 2004

We detox (the hard core alcoholics can take way more than 72 hours - one guy layed in a cardiac chair near the nurses' station completely out of it for 9 days before he cleared.)

Ours is a med-psych unit, so we get detoxers, confused geriatrics, and CMI's. Every day's a party .

The nature of psych is that it is a revolving door for all of our patient populations. The addicts relapse; the CMI's go off their meds; the elderly aggressive people get tossed out of yet another nursing home. There is very little in the way of outpatient support, so what does one expect?

RNin92 · Mar 28, 2004

Our medical detox unit is strictly 72 hours. They get their valium/librium/ativan to help pevent DTs. After 72 hours they are discharged or transferred to an inpatient dependency unit.

The problem is...our chronic ETOHers come in, especially in the frigid winter (go figure) and request detox. They know that it is 72 hours of a warm bed, free meals and meds. About the time they are ready for a drink, they sign out AMA, go on a 2-day bender, and come right back again!

So we are helping how?

Nurse Ratched, RN · Mar 28, 2004

In my state, they can't just sign out AMA. They can request DC, but the doc can decline it if the pt is a danger to himself/others. Repeated revolving door admissions are good enough reason to keep someone a little longer. We have actually even pursued (successfully) outpatient committment on those who are really abusive of the system.

It depends on the doc how things are handled. Some refuse admission on our frequent fliers. Those who know the system know they just come back the next night when a different doc is on call and try, try again.

vanburbian · Mar 28, 2004

the problem seems to be what happens after the detox is completed....why aren't they then sent to inpatient residential to continue the treatment? organically detoxing a patient is just the beginning. they need to be doing some form of continued therapy, either continued inpatient residential, or intensive outpatient, depending on their motivation, insurance, social situation, drug of choice, etc. now, if they aren't ready for that, well, then all you can do is continue to safely detox them (ETOH withdrawl DOES kill, after all) and let it go. it would be nice to make an impact on every addicts life, but it just isn't the nature of addiction. and that is my 2 cents worth, having been on both sides of this coin, as a nurse, and an addict.

sheri

RNin92 · Mar 28, 2004

In my state, they can't just sign out AMA. They can request DC, but the doc can decline it if the pt is a danger to himself/others. Repeated revolving door admissions are good enough reason to keep someone a little longer. We have actually even pursued (successfully) outpatient committment on those who are really abusive of the system.
It depends on the doc how things are handled. Some refuse admission on our frequent fliers. Those who know the system know they just come back the next night when a different doc is on call and try, try again.

Where I work, once they are decisional...they can sign out. Our Detox is not a locked unit. Psych is, but not Detox. Our detox unit is totally voluntary.

The director there has finally started refusing a few FF...but then we have to keep them in the ED until their levels are low enough to release them. If they have someone who can pick them up we can release them at that time, too.