MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES STANDARD OPERATING PROCEDURES TITLE OF PROCEDURE: SOP J-G-06 PATIENTS WITH ALCOHOL AND OTHER DRUG PROBLEMS CLINICAL POLICY: J-G-06 Patients with Alcohol and Other Drug Problems Patients with alcohol or other drug problems are assessed and medically managed in an appropriate manner. REFERENCES: NCCHC Standard J-G-06, Patients with Alcohol and Other Drug Problems CHS Clinical Policies: J-G-06, Patients with Alcohol and other Drug Problems Withdrawal Assessment Log Treatment Orders for Alcohol Withdrawal of Non-Pregnant Patients Treatment Orders for Opioid Withdrawal of Non-Pregnant Patients APPLICABILITY: Correctional Health Services (CHS) Staff PROCEDURE: A. Patients are identified for potential alcohol or other drug withdrawal during the receiving screening process, patient encounters or when notified of potential withdrawal. 1. The Registered Nurse (RN) assesses the patient in Intake or at the first notification of potential withdrawal problems related to alcohol or drugs 2. Upon assessment of the patient, the RN initiates the following actions for stated or suspected use: a. No tents housing for 14 days. b. Bottom bunk, bottom tier for 14 days. c. Encourage increased fluid intake. d. Appropriate withdrawal assessment tool twice a day for seven days by trained health staff for the following based on protocols approved by the CHS Medical Director : (1) Daily alcohol consumption: Daily use of any amount of alcohol or history of past alcoholic seizures, DTs, or hospitalization related to withdrawal. (2) One or more of the following drugs. SOP J-G-06 Patients with Alcohol and Other Drug Problems Page 1 of 4 (a) Opioids I. Heroin II. Methadone III. Oxycodone/ Oxycontin IV. Morphine V. Buprenorphine/ Subutex (b) Benzodiazepines I. Diazepam/ Valium II. Lorazepam/ Ativan III. Clonazepam/ Klonopin IV. Chlordiazpoxide/ Librium V. Oxazepam/ Serax VI. Alprazolam/ Xanax (c) Other narcotics B. Intake: 1. Patients who, during Receiving Screening, report a history of alcohol or drug withdrawal seizures, hospitalizations, or DTs from alcohol or benzodiazepines are started on medications based on appropriate Emergency Response Order (ERO) approved by the CHS Medical Director. a. These patients are administered withdrawal medications per the appropriate ERO while housed in Intake. b. Intake nurse enters alert to notify receiving facility that the withdrawal taper needs to be ordered. c. Receiving facility reviews alerts and orders withdrawal taper per the appropriate ERO. C. Outpatient clinics: 1. Patients who report a history of alcohol or drug use are assessed using the appropriate assessment. SOP J-G-06 Patients with Alcohol and Other Drug Problems Page 2 of 4 a. If scores require withdrawal medications, the provider is contacted for orders. Deviation from the standard withdrawal medication protocols is discouraged, unless the medical provider documents a reason for the change. 2. Provider reviews the Detox Dashboard daily when on site. 3. The nurse calls the healthcare provider for: a. Symptoms of withdrawal or upward trend of appropriate withdrawal assessment tool score. b. Appropriate withdrawal assessment tool score greater than 6 for Clinical Institute Withdrawal Assessment (CIWA-ar), 21 for Clinical Institute Withdrawal Assessment- Benzo (CIWA-B) or 13 for Clinical Opiate Withdrawal Scale (COWS). c. Pregnant patients with stated or suspected opioid or alcohol use. d. Any other clinical concerns. 4. RNs are able to discontinue withdrawal assessment tool when the “recommend DC” button is displayed in the EHR D. Patients are transferred to hospital as medically appropriate based on nursing assessment and provider order. E. Patients are referred to Mental Health services by the healthcare provider as appropriate. F. Patients started on withdrawal assessment protocols are offered Patient Information Sheets on Alcoholic Anonymous Meeting locations and/or Methadone Clinics as appropriate. DEFINITIONS: None EVALUATION REVIEW CRITERION This standard operating procedure is to be reviewed annually. ATTACHMENTS None SOP J-G-06 Patients with Alcohol and Other Drug Problems Page 3 of 4 Revision History Originated Date: 07/16/13 Revision Date Revision Description Employee Notification Addendum to Section C: Outpatient Clinics 1a. 2/16/16 ***Deviation from the standard withdrawal medication protocols is discouraged, 3/15/16 unless the medical provider documents a reason for the change. 4/15/16 Modification to language in section C:4 4/15/16 SOP J-G-06 Patients with Alcohol and Other Drug Problems Page 4 of 4 .