Responsible Compassionate Care: Meeting the Needs of Patients with a History of Intravenous Drug Abuse

Hawes, Michelle L.; Willegal, Kate M.

doi:10.1016/j.java.2016.08.004

Cited by 3 publications

(2 citation statements)

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“…Meanwhile, staff may consider periodic laboratory monitoring to identify and treat incipient infections due to drug use [17]. Several outpatient clinics have established patient care plans, which have included verbal or written agreements from patients to refrain from injecting into their VADs [13,14,51,52]. Clinics have also utilized specialized dressing or security seals on patients' VADs to more easily detect drug use [13,14,51,52].…”

Section: Discussionmentioning

confidence: 99%

“…Several outpatient clinics have established patient care plans, which have included verbal or written agreements from patients to refrain from injecting into their VADs [13,14,51,52]. Clinics have also utilized specialized dressing or security seals on patients' VADs to more easily detect drug use [13,14,51,52]. However, these technologies were not employed in our study setting, and patients' perspectives of these preventive measures are currently unknown, as is their effectiveness for preventing harm to patients.…”

Section: Discussionmentioning

confidence: 99%

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“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

et al. 2022

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Background Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians’ concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms. Methods Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually. Results A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms. Conclusions VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

et al. 2022

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Self-injecting non-prescribed substances into vascular access devices: a case study of one health system’s ongoing journey from clinical concern to practice and policy response

et al. 2022

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Background Overdose-associated deaths and morbidity related to substance use is a global public health emergency with devastating social and economic costs. Complications of substance use are most pronounced among people who inject drugs (PWID), particularly infections, resulting in increased risk of hospitalization. PWID often require intravenous access for medical treatments such as antibiotics; however, vascular access may be limited due to the impacts of long-term self-venipuncture. While vascular access devices including peripherally inserted central catheters (PICCs) allow reliable and sustained routes of administration for indicated therapies, the use of PICCs among PWID presents unique challenges. The incidence and risks associated with self-injecting non-prescribed substances into vascular access devices (SIVAD) is one such concern for which there is limited evidence and absence of formal practice guidance. Case presentation We report the experience of a multidisciplinary team at a health organization in Vancouver, Canada, working to characterize the incidence, patient and healthcare provider perspectives, and overall impact of SIVAD. The case study of SIVAD begins with a patient’s perspective, including patient rationale for SIVAD, understanding of risks and the varying responses given by healthcare providers following disclosure of SIVAD. Using the limited literature available on the subject, we summarize the intersection of SIVAD and substance use and outline known and anticipated health risks. The case study is further contextualized by experience from a Vancouver in-hospital Overdose Prevention Site (OPS), where 37% of all individual visits involve SIVAD. The case study concludes by describing the systematic process by which local clinical guidance for SIVAD harm reduction was developed with stakeholder engagement, medical ethics consultation, expert consensus guideline development and implementation with staff education and planned research evaluation. Conclusion SIVAD is encountered with enough frequency in an urban healthcare setting in Vancouver, Canada, to warrant an organizational approach. This case study aims to enhance appreciation of SIVAD as a common and complex clinical issue with anticipated health risks. The authors conclude that using a harm reduction lens for SIVAD policy and research can provide benefit to clinicians and patients by offering a clear and a consistent healthcare response to this common issue.

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A Pilot Program of Interprofessional Care for the Patient with a History of Injectable Drug Use Requiring Intravenous Medication

Hawes

2022

Journal of the Association for Vascular Access

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Highlights Abstract Background: The use of injectable drugs and alcohol increased during the months of lockdown and continual uncertainty of the worldwide response to the COVID-19 virus and its variants. As the world adjusts to living with multiple transmissible viruses, the health care system needs a comprehensive approach to care for people who inject drugs. Although the problem of injectable drug use is wide-ranging, this article will focus on the intersection of the person who injects drugs and the health care system. Methods & Findings: After an initial case involving a person who injects drugs requiring 42 days of intravenous antibiotics, the hospital began to develop plans to care for this patient population. Finding gaps in the research, a team at the hospital developed a Substance Use Risk Reduction Program that included a risk assessment scale, an interprofessional communication plan, and a set of protocols, then trialed these components between 2017 and 2019. The program successfully screened and collaborated care for patients with a history of injectable drug use. The goals to increase safety were addressed through the protocols that included tamper-evident technology and frequent observations by the staff. The risks of blood stream infection and overdose while a patient was in the hospital were reduced by using the risk reduction protocols. In addition, repudiated costs were decreased by thousands of dollars because of early planning for transfer from inpatient to outpatient, skilled nursing facility, or long-term acute care for the completion of intravenous therapy.

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Responsible Compassionate Care: Meeting the Needs of Patients with a History of Intravenous Drug Abuse

Cited by 3 publications

References 1 publication

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

Self-injecting non-prescribed substances into vascular access devices: a case study of one health system’s ongoing journey from clinical concern to practice and policy response

A Pilot Program of Interprofessional Care for the Patient with a History of Injectable Drug Use Requiring Intravenous Medication

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