Controversial Hospital Policy Targets Opioid-addicted Patients

By Joan Spitrey via Multibriefs

As the opioid crisis continues to hold the nation captive, some new, innovative approaches are being attempted to at least manage certain aspects of the crisis.

The University of Tennessee Medical Center (UTMC) in Knoxville will now require patients admitted for medical treatments of drug-use-related infections to comply with new conduct rules. The goal is to create a safer environment for both patients and staff.

The new policy, similar to one implemented in Providence Regional Medical Center in Everett, Washington, will require the patients to agree to a search by security, turn over their clothing and all personal property, including cellphones, not be able to leave the floor and to receive no visitors. If they cannot comply with the agreement, they must leave.

Tennessee ranks 13th in the United States in opioid-related overdose deaths, with Knox County, home to UTMC, leading the state. So, it was no surprise that UTMC needed to find innovative ways to help treat this challenging population. Although it appears extreme, UTMC officials found that the changes were necessary and have worked.

"This is done first and foremost for patient safety," said Dr. Jerry Epps, UTMC's senior vice president and chief medical officer. "When patients are bringing in needles and drugs, and their friends are coming in with drugs, and they can shoot up in the bathroom and maybe kill themselves, I argue we're doing our best to protect patients and team members from this dreadful problem."

Although a small portion of the actual inpatient population, patients admitted for drug-use-related infections tend to be in the hospital for weeks receiving treatment. This creates a unique set of challenges when these patients sometimes bring other problems with them to the hospital — illicit drugs, unsavory associates, defiant attitudes, bad personal hygiene, crime, chaos and the ever-present threat of an overdose death.

"As the region’s academic medical center, we have an obligation to take a leadership role in addressing and seeking solutions for serious health-related matters facing our community, such as the opioid epidemic," said Joe Landsman, president and CEO of UTMC.

Dr. Epps first learned of the gravity of the problem last year from UTMC staffers. He learned that large amounts of drugs and paraphernalia were being confiscated by security, the verbal abuse staff endured, drug deals taking place, and the lack of consistency on the plan of care for these patients.

This left the nurses making moral judgments while caring for these patients. UTMC staff feared that the nurses would become overwhelmed and start leaving.

With the new policy and plan of care in place, there is a united front. No longer can the patients play the individual nurses and doctors against each other. Since the implementation, the nursing staff has been rejuvenated and do not feel burdened when carrying for this patient population.

"It's one of the best things we've done for our team members to help them become more empathetic," said Janell Cecil, UTMC's chief nursing officer. "They aren't being berated and abused, and that has changed the attitude of everyone involved."

As the patient continues their care in the hospital, their plan of care can be modified to allow them to earn back certain privileges, such as their cellphone or outside visits. Also, while admitted, attempts are made to get the patients into residential medication-assisted treatment, which continues to be a challenge.

"The lack of addiction treatment resources is the most disheartening thing for our team members," Epps said. "Only 10% of our patients are getting addiction treatment. That's appalling."

Although the new policy has sparked some debate among addiction and ethics experts, most find that the short-term restrictions are acceptable in exchange for increases success with treatment in a difficult population. However, all agree that with this complex and challenging problem, there will need to be insightful, revolutionary and complex solutions.

Joan Spitrey has been a registered nurse for more than 16 years, specializing in critical care and acute care services. She currently is a clinical nursing instructor, sharing her passion with the next generation of nurses. She can be found blogging at TheNurseTeacher.com.