Evidence Based Practice

Table of Contents

Introduction.

Analysis, examination and identification of relevant issues.

Immediate assessment and screening tools.

Comprehensive assessment

Immediate interventions.

Appropriate management strategies and treatment models.

Any other health professionals needed.

Conclusion.

Reference List

Introduction to Evidence Based Practice

An emergency case of drug and substance abuse has been considered for analysis and process with a medical examination to help the individual whose medical case has been considered for examination. The case study analysis involves identification of the medical issues within the patient who has been admitted in the emergency department of a hospital. Identification of the medical issues is processed after understanding the medical history as well as the processing with the examination of the existing mental state of the patient. The immediate assessment along with the screening tool helps in processing with the identification of the patient focusing on the mental and physical condition of the patient along with focusing on the medical and mental requirement of the patient to ensure their immediate relief.

The comprehensive assessment is one of the important factors in case analysis focusing on the safety of the patient and avoiding the risk of homicide or self-harm due to the mentality of misadventure. Searching tools can be considered for processing with the comprehensive assessment and identifying the medical issues while confirming the identified risk with the patient. The immediate intervention focuses on the risk assessment to ensure safety as well as the responsibility of the PRN while ensuring relaxation within the patient as well as booking them with an appointment for the psychiatric registrar. Analysing the appropriate management strategies which include medical treatment models focusing on the requirement of the patient and understanding the requirement of other health professionals within the planning considered for providing care to the patient are the important stages while analysing the provided case study regarding drug and substance abuse.

Analysis, Examination and Identification of Relevant Issues

Tom is a 19-year-old labourer living with his mother whose father has been alcoholic and left the family when he was 8 years old. Tom was admitted to the emergency department by the police under section 22 of the mental health act when a passer-by identified Tom who was bleeding and lying on the road. The report presented by police depicted that directly refusing to be admitted in hospital that forced the ambulance to call him for the police who found Tom shouting bad is better off dead and it was evident that he had psychotic illness due to the improper and over-induction of drugs. while he was admitted in the emergency department he had a lacerated arm and was appearing to be heavily intoxicated. It was observed that his blood alcohol concentration was recorded to be 0.22g/%.

While processing with physical examination it was observed that there are several superficial scratches along with 2.5 cm long laceration to his left arm. Upon integrating about the scratches and lacerated left arm he mentioned that he had no intention of committing suicide however he just cut himself with the bottle out of depression and had no intention of killing himself. It has been further identified that he had several acne type lesions that could have been due to the use of drugs like CMA or heroin. His appearance and behaviour included an unkempt young man who was unstable throughout the interview processed by the medical officer while seeming hyper-vigilance and intense eye contact noted as well as being cooperative but guarded.

Examination indicated that his mood was agitated and volatile even though he claims to be fine. There were minor irregularities in his speech which involved direct and clipped rhythm while answering in a few words which are not monosyllables. There was an irregularity in his thinking pattern because he was providing some irrelevant answers however he was able to cover up the irrelevant answers. He further explained that he cut himself with bottles when he is depressed however, not intending to end his life.

He has no idea why he does so and he mentioned that he had been arrested as well as charged for 3 break and entering offences as well as one assault but mentions that someone has framed him. Analysing his medical history and the elements identified during the physical examination it can be stated that there exists the possibility of personality vulnerabilities along with personality disorder and have evidence proving the psychotic illness. The psychotic illness has developed due to the drug-induced psychosis instead of schizophrenia because he was able to remember other instances of cutting himself without intending to end his life.

It was observed that he was initially hostile after his laceration was treated that indicated the instances of withdrawal along with certain major mental illness. It can be recorded that he had symptoms of withdrawal from alcohol and drugs along with having initial symptoms of psychosis. He has been charged for criminal offences and claims to be framed by an unnamed individual that generates the scope of visual and auditory hallucination. Overall, for the proper planning of the management team, it can be specified that Tom has withdrawal symptoms along with the initial stage of psychosis which can be treated by contacting the psychiatrist and planning sessions with the psychiatrist as it was everything that he had certain mental issues starting from personality disorder to being depressed.

Immediate Assessment and Screening Tools

The immediate assessment and screening tool that can be considered for processing with the medical examination and receiving a medical history of Tom includes processing weather risk assessment from the perspective of mental stability and identifying the significance of his injuries focusing on the necessity of admission in hospital as well as considering admitting him in ICU. The screening tool might include processing with a blood test to identify the blood alcohol concentration along with appointing a psychiatric professional to recognise his possibility of psychotic illness and determining the chances of being schizophrenic or psychosis due to the improper induction of drugs (Jauregui, P., Estevez, A. and Urbiola 2016).

The psychiatrist will be able to focus on the possibility of suicide attempts and identify the instances of medical intervention in the medical history of Tom. The conversation with Tom can be considered as a screening tool that helps the professional to identify the possibility of personality disorder or withdrawal from substance abuses. The utilisation of immediate assessment and screening tools would help in having a clear medical report that can be used as a base on which the entire treatment plan of Tom will focus. It is necessary to have an idea about the disease and chances of committing suicides to analyse the requirement of active participation of the psychiatrist and ensure that Tom can find his depression without committing suicide.

Comprehensive Assessment

The comprehensive assessment Tom would include initial assessment regarding the safety of Tom focusing on reducing the risk for homicides and suicides or causing self-harm out of curiosity and misadventure. The medical tool such as AUDIT-C can be considered for alcohol dependence since some of the risk assessment tools are becoming less oriented towards evidence and cannot be effectively used for assessing the potential risk that might threaten the patient. The AUDIT-C is the screening tool used for identifying the person who is having active alcohol use disorders along with being hazardous drinkers (Khadjesari et al., 2017). The screening tool consists of a questionnaire focusing on the habits of drinking focusing on the intensity and pattern of drinks consumed by the drinker.

The score of the screening test ranges from 0 to 12 mentioning that the highest score indicates the fact that the drinking habit of the patient has become a concern regarding maintenance of medical safety of the patient (Eyawo et al., 2018). The symptoms observed in Tom indicated that he had been a regular drinker and had been drinking since 1900 hours the previous day. It is necessary to process with the particulars screening test and examine Tom to identify his capability to counter the safety issues that might develop within his body due to the sudden withdrawal as well as the laceration throughout his body.

The physical examination of Tom indicated that he has symptoms of delirious cognitive impairment which can be confirmed by using bedside cognitive tests such as Montreal cognitive assessment (MOCA) which helps in protecting the cognitive impairment within the patient (Julayanont and Nasreddine 2017). The cognitive assessment helps in identifying the neurological diseases as well as depression and schizophrenia within the patients. Cognitive assessment focusing on the mental stability of the patient helps the hospital authority to determine the capability of the patient to live alone file receiving home aid without harming themselves (Roalf et al., 2016).

Tom has several superficial scratches on his body that generates the scope of self-harm as well as attempting genuine suicide which needs to be identified as fast as possible to reduce the chances of successful suicide attempts. The guidelines for comorbidity can be considered as one of the best assessment tools for confirming the existence of multiple medical conditions with the primary medical disorders of the patient admitted against hazardous drinking. Commodity guidelines developed by the Centre of Research Excellence in Mental Health and Substance Uses (CREMS), University of South Wales Sydney, developed guidelines as well as providing online training programs through their website to ensure the healthcare providers can handle the patients who have been admitted in the medical institute having the medical history of substance and drug abuse (Netfront 2020). The website provides guidelines training as well as resources that can be used to help the patients who have been admitted for receiving care and help to withdraw from the alcohol as well as drugs and substance abuses. 

Immediate Interventions

The immediate intervention that might be required to provide care to Tom who has been admitted to the emergency department while considering to be delirious as well as giving symptoms of being suicidal. The immediate intervention must be initiated by the identification of delirious within Tom by considering the MOCA and AUDIT-C test and considering the risk that can be observed in the immediate safety provided to the patient. After the proper risk assessment of the immediate safety provided to Tom, it is necessary to offer PRN medications that help in restricting the mind of the patient from suicidal and depressing thoughts while providing relaxation to the mind of the patient. It is necessary to conduct urine drug screening in order to determine the suspected medical problem due to drugs and alcohol before planning the treatment process.

The test regarding the urine drug needs to be performed regularly to identify that patients receiving treatment for substance abusers are able to stay sober and are able to fight the craving for the substances which are commonly abused (Sundström, Pelander and Ojanperä 2017). The test helps in planning as well as processing with the activities of the withdrawal and measuring the withdrawal scale. The immediate intervention includes having a clarifier knowledge about the patient depending on other substances such as opiates that need to be medically replaced while planning the withdrawal process within a patient receiving treatment for substance abuse.

Apart from analysing and considering the medical factors and prescribing medications to ensure relief for the patient, it is necessary to consult a psychiatry registrar because he has been admitted to the hospital under the section which requires review in 12 hours in form of written documents. Immediate intervention provided to the patient helps in dealing with the legal aspect along with the medical perspective as well as psychiatric focus.

Appropriate Management Strategies and Treatment Models

The appropriate management strategies, as well as treatment models that could be included in the treatment plan developed for Tom, involves the utilisation of AUDIT-C as well as MOCA along with following the morbidity guide presented by CREMS. It is necessary to include all the crucial assessment tests to identify the potential additional conditions existing within the body of the patient along with hazardous drinking. The test will help in identifying the existence of other drugs that need to be medically replaced to ensure that Tom is able to stay sober while receiving treatment for his unstable medical situation. The overarching treatment model would be one of morbidity which would be focusing on his assessment as well as diagnosis of mental illness as a substance abuse by treating both simultaneously (Zackoff, Iyer and Dewan 2018).

The treatment and diagnosis within the same time would help in proper planning of the activities that would not only decrease the existing concentration of unwanted substances within the body along with helping the patient to control the urge of consuming the unwanted substances while maintaining to stay sober (Kopecek et al., 2017). Appropriate management strategy might consider following the guidelines of CREMS and including the worksheets to identify the negative thoughts as well as focusing on the visualisation capacity of the patients to determine the effect of hallucination and incorporate medicines accordingly (Gilbert, Daffern and Anderson 2017). The urine drug test indicates the existence of other drugs within Tom's body that might have been influencing his thinking ability that has been observed while processing with the interview of regular medical examination.

Any Other Health Professionals Needed

The treatment of a patient having an addiction to drugs and alcohol needs immediate medical intervention along with assistance from another health professional. It is necessary to have an idea about the disease and chances of committing suicides to analyse the requirement of active participation of the psychiatrist and ensure that Tom is able to find his depression without committing suicide. The additional professionals can provide aid along with providing care while maintaining the patient care as well as soberness within the admitted patient (Abbasi and Hatami Varzaneh 2019). The main additional professional who would be the assistant treatment of Tom is psychiatrist since there are higher chances of delirious as well as psychotic illness.

The medical officer along with the registered nurses were able to identify depression along with psychotic illness which increased the necessity of involving the psychiatric as additional Health care professionals providing aid and planning treatment procedures for Tom. It was further observed that Tom was having a certain acne type lesion on his face which indicated that the dermatologist needs to be consulted for identifying the substances that might be the reason behind the marks on the face. The face marks are often observed due to the use of certain drugs such as CM a and heroin that would directly increase the risk of skin myocardial infection.

Overall, along with the medical officer and the registered nurses, it is necessary to have additional health professionals would be consulted and considered in the team responsible for generating the treatment plan for Tom. Additional health professionals would include the psychiatric registrar along with the dermatologist who would be helping in identifying the chances of other drugs within the body of Tom that would be confirmed by the several tests suggesting urine drug tests (Nelson, Stellpflug and Engebretsen 2016). The health professionals consult within themselves and prepare a plan that would be effective in helping Tom regarding receiving healthcare and staying sober.

Conclusion on Evidence Based Practice

An emergency case of drug and substance abuse has been considered for analysis and process with a medical examination to help the individual whose medical case has been considered for examination. The case study analysis involves identification of the medical issues within the patient who has been admitted in the emergency department of a hospital. For the proper planning of the management team, it can be specified that Tom has withdrawal symptoms along with the initial stage of psychosis which can be treated by contacting the psychiatrist and planning sessions with the psychiatrist as it was everything that he had certain mental issues starting from personality disorder to being depressed.

It is necessary to process with the AUDIT-C test and examine Tom to identify his capability to counter the safety issues that might develop within his body due to the sudden withdrawal as well as the laceration throughout his body. The Centre of Research Excellence in Mental Health and Substance Uses (CREMS), University of South Wales Sydney, developed guidelines as well as providing online training programs through their website to ensure the healthcare providers are able to handle the patients who have been admitted in the medical institute having the medical history of substance and drug abuse. Immediate intervention provided to the patient helps in dealing with the legal aspect along with the medical perspective as well as psychiatric focus.

Reference List for Evidence Based Practice

Abbasi, H.R. and Hatami Varzaneh, A., 2019. Investigation of the Factors Affecting Successful Treatment of Drug Abuse with Grounded Theory Approach. Journal of Qualitative Research in Health Sciences, 8(1), pp.10-21.

Eyawo, O., McGinnis, K.A., Justice, A.C., Fiellin, D.A., Hahn, J.A., Williams, E.C., Gordon, A.J., Marshall, B.D., Kraemer, K.L., Crystal, S. and Gaither, J.R., 2018. Alcohol and mortality: combining self-reported (AUDIT-C) and biomarker detected (PEth) alcohol measures among HIV infected and uninfected. Journal of acquired immune deficiency syndromes (1999), 77(2), p.135.

Gilbert, F., Daffern, M. and Anderson, C.A., 2017. The General Aggression Model and its application to violent offender assessment and treatment. The Wiley handbook of violence and aggression, pp.1-13.

Jauregui, P., Estevez, A. and Urbiola, I., 2016. Pathological gambling and associated drug and alcohol abuse, emotion regulation, and anxious-depressive symptomatology. Journal of behavioral addictions, 5(2), pp.251-260.

Julayanont, P. and Nasreddine, Z.S., 2017. Montreal Cognitive Assessment (MoCA): concept and clinical review. In Cognitive screening instruments (pp. 139-195). Springer, Cham.

Khadjesari, Z., White, I.R., McCambridge, J., Marston, L., Wallace, P., Godfrey, C. and Murray, E., 2017. Validation of the AUDIT-C in adults seeking help with their drinking online. Addiction science & clinical practice, 12(1), p.2.

Kopecek, M., Stepankova, H., Lukavsky, J., Ripova, D., Nikolai, T. and Bezdicek, O., 2017. Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. Applied Neuropsychology: Adult, 24(1), pp.23-29.

Nelson, Z.J., Stellpflug, S.J. and Engebretsen, K.M., 2016. What can a urine drug screening immunoassay really tell us?. Journal of pharmacy practice, 29(5), pp.516-526.

Netfront, D. (2020) About the Guidelines, Comorbidityguidelines.org.au. Available at: https://comorbidityguidelines.org.au/about (Accessed: 18 May 2020).

Roalf, D.R., Moore, T.M., Wolk, D.A., Arnold, S.E., Mechanic-Hamilton, D., Rick, J., Kabadi, S., Ruparel, K., Chen-Plotkin, A.S., Chahine, L.M. and Dahodwala, N.A., 2016. Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease. Journal of Neurology, Neurosurgery & Psychiatry, 87(12), pp.1303-1310.

Sundström, M., Pelander, A. and Ojanperä, I., 2017. Comparison of post-targeted and pre-targeted urine drug screening by UHPLC–HR-QTOFMS. Journal of analytical toxicology, 41(7), pp.623-630.

Zackoff, M.W., Iyer, S. and Dewan, M., 2018. An overarching approach for acute care delivery: extension of the acute care model to the entire inpatient admission. Translational pediatrics, 7(4), p.246.

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