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Addiction Inpatient Redesign Project

Concord Repatriation General Hospital
Project Added:
19 August 2014
Last updated:
10 October 2014

Addiction Inpatient Redesign Project (AIR)

Concord Repatriation General Hospital, Sydney Local Health District

Summary

The project aims to streamline the admission process to the two drug health wards. From admission, staff will work with the patient to develop a comprehensive care plan for their discharge back to the community, ensuring access to education and services to help keep them well. This will in turn reduce the number who are readmitted after relapse and help to keep people healthy in their community.

Download a poster about this project from the Centre for Healthcare Redesign graduation, August 2014.

Aim

The project goal is to develop and document a model of care for in-patient drug health services at Concord Repatriation General Hospital (CRGH) that will enable the provision of comprehensive care for patients with complex drug health, physical health and mental health co-morbidities.

Benefits

The project will provide a better service for patients by providing individualised care planning to ensure the most appropriate treatment and discharge planning.

The success of this project will create an environment in which patients manage their care more independently. This will lead to a decrease in patients needing to present to Emergency Departments in crisis.

Project status

Started August 2013.

Background

In-patient services at Concord Drug Health include a 12 bed withdrawal management unit (Ward 64, 5-7 day stay) and a 12 bed rehabilitation unit (Ward 65, 28 day stay).

Sydney Local Health District has undertaken this project in recognition of the changing face of service delivery and changing needs of our patients with addiction issues. Non–government services are by and large meeting the needs for patients requiring assistance with rehabilitation. However, there are gaps in service provision for patients with more complex mental and physical health issues that accompany their addiction. This group of patients is currently being accommodated in other acute units in hospitals, without the specialist level of expertise and skill to manage their problems effectively.

They are often even declined hospital admission and do not receive adequate treatment. Consequently, these patients have multiple re-presentations to emergency departments and multiple readmissions.

This program was initially developed over 20 years ago and effectively met the needs of the patients it was designed to meet at that time.

Some elements of the service that needed to change to meet the current needs for patients included:

  • Broadening the admission criteria to meet the current client group
  • Effectively working with patients to build individualised, evidence based care of patients
  • Adapting the current programs to meet broader patient requirements.

Solutions implemented

Care processes and content have been extensively reviewed and revised. The service is progressing well with a staged implementation.

Changing the service focus and delivery has required the active involvement of staff including investment by local health services in the training required to meet the patient needs.

The nursing team took part in a focussed week of training comprising of Dialectical Behavioural Therapy, motivational Interviewing, DETECT and Manual Handling etc in December 2013. In order to achieve a more patient focussed approach to care the nursing team has been involved in the development and training for Individualised care plans. This was implemented in July 2014. Training for the modular program commenced in April 2014.

Evaluation

The below key performance indicators (KPIs) will be used to monitor progress and perform adequate evaluation of solutions implemented:

  • Readmission rates of patients to ward 64
  • Representation rates of patients to local Emergency departments
  • Increase in staff satisfaction
  • Maintaining patient satisfaction during and after the change

Lessons learnt

  • Need to have a set time for completion of one program in order to transition to another program.
  • Difficulty in effecting change in a largely part time workforce.

References

Bowen S, Chawla N, Collins S, Witkiewitz K, Hse S, Grow J et al, (2009). Mindfulness based relapse prevention for substance use disorders: A pilot efficacy trial. Journal of Substance Abuse. 30: 295-305

Draper B, Karmel R, Gibson D, Peut A, Anderson P. (2011). Alcohol-related cognitive impairment in New South Wales hospital patients aged 50 years and over. Australian & New Zealand Journal of Psychiatry. 45(11):985-92

Han B, Gfroerer JC, Colliver JD, Penne MA (2009). Substance use disorder among older adults in the United States in 2020. Addiction. 104(1):88-96

Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welsh SS, Heagerty P et al, (2002). Dialectical behaviour therapy versus comprehensive validation therapy plus 12 step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence. 67:13-26

Linehan MM, Korslund KE, Lynch TR, Harned MS, Rosenthal Z. (2009, November). Randomised controlled trial of DBT vs drug counselling for opiate dependent BPD men and women. Paper presented at the annual convention of the Association for the Behavioural and Cognitive Therapies, New York, NY.

Garland EL, Gaylord SA, Boettiger CA, Howard MO. (2010). Mindfulness training modifies cognitive, affective and physiological mechanisms implicated in alcohol dependence: Results of a randomised controlled pilot trial. Journal of Psychoactive Drugs. 42:177-192

McHugh RK, Hearon BA, Otto MW. Cognitive behavioural therapy for substance use disorders. Psychiatric Clinics of North America. 2010 Sep;33(3):511-25.

Zgierska A, Rabago D, Chawla D, Kushner K, Koehler R, Marlatt A, (2009). Mindfulness meditation for substance use disorders: A systematic review. Substance abuse. 30:266-294

Contacts


Head of Department
Addiction Medicine, Central Clinical School
University of Sydney
Phone: 02 9767 8320


Nurse Unit Manager
Concord Repatriation General Hospital, Sydney Local Health District
Phone: 02 9767 8600


Addiction Psychiatrist
Concord Repatriation General Hospital, Sydney Local Health District
Phone: 02 9767 8320

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