Nurse leaders at Providence Regional Medical Center in Everett, Wash., say they launched their written partnership agreement with drug-addicted infection patients four years ago in their 30-bed close-observation unit, a medical-surgical floor for patients with substance abuse and/or psychiatric disorders.
It grew out of patients' disruptive behavior and the possession and use of illicit drugs in the hospital.
The nurses say the program has been highly successful in helping staff manage these patients, and has since been adopted by other Providence St. Joseph Health hospitals. It also served as a model for a stricter approach used at the University of Tennessee Medical Center.
But they stress that Providence applies the rules flexibly, for instance not taking patients' cellphones unless they use them to score drugs. And the hospital doesn't kick patients out if they refuse to sign the agreement.
“We try to do it as a collaborative agreement and try not to put any shame around substance abuse,” said Gale Springer, a mental health clinical nurse specialist. “We started out more restrictive on visitors, and we loosened that as the staff got more capable at figuring out who the risky visitors were. My guess is the Tennessee folks will relax the rules, too.”
Still, in the last six months of 2017, 9% of Providence Regional's patients who were admitted for drug-use related infections left when presented with the written agreement, and another 25% left against medical advice during their treatment stay.
With so many patients leaving, Providence is trying to gear up more outpatient antibiotic treatment.
“The rate of patients leaving is higher than we'd like to see,” said Springer, who added that staff members are working on better management of patients' pain and opioid withdrawal symptoms.