scholarly journals The hidden cost of not having a dual diagnosis team (an audit looking at inpatient admissions for Redbridge Community Recovery Team West)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S65-S66
Author(s):  
Madeeha Bandukda ◽  
Muhammad Aadil Bhenick ◽  
Najam Chaudry ◽  
Henok Getachew
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Dual Diagnosis ◽  
Drug Screening ◽  
Substance Misuse ◽  
Drug Misuse ◽  
Urine Drug Screen ◽  
Mental Health Act ◽  
Urine Drug ◽  
Urine Drug Screening

AimsCo-existing mental illness and substance misuse is highly prevalent within the UK, with approximately 40% of people diagnosed with psychosis having a history of substance misuse. However, in Redbridge we currently do not have access to a dual diagnosis team or integrated care.This audit aims to assess the health and social implications of fragmented care, plus the effectiveness of mental health services in assessing patients with dual diagnosis and referring to specialist misuse teams. We used the NICE guidelines on co-existing severe mental illness and substance misuse [CG120] to help guide our recommendations.MethodWe identified 50 out of 359 patients within our service who were admitted to psychiatric hospital over a one year period (between 01/11/2019- 01/11/2020).We looked at medication compliance, use of the Mental Health Act and accommodation status to compare between those with and without known dual diagnosis. We used frequency and length of admission as indicators of how successfully patients were being managed in the community and the cost to the hospital trust. Urine drug screening and referral to substance misuse services were chosen as markers of whether patients were being appropriately managed on admission.ResultA higher percentage of patients with dual diagnosis were detained under the Mental Health Act compared to those without substance misuse (89% versus 72%). They were more likely to have no fixed abode (28% versus 13%) and be non-compliant with treatment pre-admission (83% versus 56%). Patients with dual diagnosis also had a higher number of hospital admissions, with a greater proportion having 3 admissions that year (11% versus 3%).Only 50% of patients with known dual diagnosis had a urine drug screen performed on admission and just 25% of patients who were currently misusing substances were referred to specialist services by the inpatient team.ConclusionOur audit found that there are overall poorer outcomes for patients with dual diagnosis versus a psychiatric illness only. It is evident that integration of services will improve the care we are able to provide and reduce costs associated with multiple admissions to hospital.We identified three key areas for improvement. Firstly, we advised on the need to improve documentation. Additionally, we recommend ensuring assessment of current drug misuse is done on admission, including performing simple tests such as urine drug screening. Finally, we highlighted the need to improve discussions about substance misuse with patients, within teams and between services, aiming for integrated and holistic care.

Urine Drug Screening

2001 ◽  
Vol 11 (3) ◽  
pp. 18???22
Author(s):  
Albert Jekelis
Keyword(s):  
Drug Screening ◽  
Urine Drug ◽  
Urine Drug Screening

scholarly journals Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Heath Care System

2020 ◽  
Author(s):  
Tessa Rife ◽  
Christina Tat ◽  
Mahsa Malakootian
Keyword(s):  
San Francisco ◽  
Knee Arthroplasty ◽  
Risk Mitigation ◽  
Opioid Therapy ◽  
Veterans Affairs ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Urine Drug ◽  
Medication Disposal ◽  
Urine Drug Screening

Abstract Purpose Guidelines recommend evaluating the risk of opioid-related adverse events prior to initiating opioid therapy. The orthopedic service at San Francisco Veterans Affairs Health Care System (SFVHCS) has not routinely used risk assessment tools such as the Stratification Tool for Opioid Risk Mitigation, prescription drug monitoring program data, and urine drug screening prior to opioid prescribing. A quality improvement project was conducted to evaluate the number of pharmacist-provided opioid risk mitigation recommendations implemented by orthopedic providers for patients who underwent total hip or knee arthroplasty at SFVHCS. Summary A pharmacist-led workflow for completing risk mitigation reviews was developed in collaboration with orthopedic providers, and urine drug screening was added to the preoperative laboratory testing protocol. The following recommendations were communicated via electronic medical record: limit postoperative opioids to a 7- or 14-day supply based on risk of suicide and/or overdose, offer naloxone and a medication disposal bag, and order a urine drug screen if not already completed. Risk reviews were completed for 75 patients. Among 64 patients with 2-month postdischarge data available, 88% (7 of 8) of 7-day and 79% (44 of 56) of 14-day opioid supply recommendations were implemented; 41% (26 of 59) of recommendations to issue a medication disposal bag, 17% (2 of 12) recommendations to order a missing urine drug screen, and 9% (5 of 55) of recommendations to offer naloxone were implemented. Conclusion Pharmacist-performed risk mitigation reviews paired with individualized recommendations led to high rates of orthopedic provider acceptance of limiting postdischarge opioid day supplies for patients who had total hip or knee arthroplasty. Alternative strategies may increase access to naloxone. Future research should examine the impact of risk mitigation tools in reducing prescribing of long-term opioid therapy and adverse events among orthopedic surgical patients.

Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing

2007 ◽  
Vol 33 (1) ◽  
pp. 33-42 ◽  
Author(s):  
William B. Jaffee ◽  
Elisa Trucco ◽  
Sharon Levy ◽  
Roger D. Weiss
Keyword(s):  
Systematic Review ◽  
Drug Screening ◽  
Urine Drug ◽  
Urine Drug Screening

Do community mental health teams caring for severely mentally ill patients adjust treatments and services based on patients’ antisocial or criminal behaviours?

2009 ◽  
Vol 24 (6) ◽  
pp. 373-379 ◽  
Author(s):  
S. Hodgins ◽  
A. Cree ◽  
F. Khalid ◽  
K. Patel ◽  
R. Sainz-Fuentes ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Aggressive Behaviour ◽  
Service Use ◽  
Substance Misuse ◽  
Illicit Drug ◽  
Antisocial Behaviour ◽  
Positive Symptoms ◽  
Severely Mentally Ill

AbstractBackgroundAntisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation.AimTo determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour.MethodA random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files.ResultsPast antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits.ConclusionsWhile the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.

Urine Drug Screening in the Era of Designer Benzodiazepines: Comparison of Three Immunoassay Platforms, LC-QTOF-MS, and LC-MS/MS

2021 ◽  
Author(s):  
Andrii Puzyrenko ◽  
Dan Wang ◽  
Randy Schneider ◽  
Greg Wallace ◽  
Sara Schreiber ◽  
...  
Keyword(s):  
Drug Screening ◽  
Forensic Toxicology ◽  
Confirmatory Testing ◽  
Urine Drug ◽  
Screening Assays ◽  
Us Fda ◽  
Urine Specimens ◽  
Abbott Architect ◽  
Designer Benzodiazepines ◽  
Urine Drug Screening

ABSTRACT This study investigated the presence of designer benzodiazepines in 35 urine specimens obtained from emergency department patients undergoing urine drug screening. All specimens showed apparent false-positive benzodiazepine screening results (i.e., confirmatory testing using a 19-component LC-MS/MS panel showed no prescribed benzodiazepines at detectable levels). The primary aims were to identify the possible presence of designer benzodiazepines, characterize the reactivity of commercially available screening immunoassays with designer benzodiazepines, and evaluate the risk of inappropriately ruling out designer benzodiazepine use when utilizing common urine drug screening and confirmatory tests. Specimens were obtained from emergency departments of a single US Health system. Following clinically ordered drug screening using Abbott ARCHITECT c assays and lab-developed LC-MS/MS confirmatory testing, additional characterization was performed for investigative purposes. Specifically, urine specimens were screened using two additional assays (Roche cobas c502, Siemens Dimension Vista) and LC-QTOF-MS to identify presumptively positive species, including benzodiazepines and non-benzodiazepines. Finally, targeted, qualitative LC-MS/MS was performed to confirm the presence of 12 designer benzodiazepines. Following benzodiazepine detection using the Abbott ARCHITECT, benzodiazepines were subsequently detected in 28/35 and 35/35 urine specimens, respectively, using Siemens and Roche assays. LC-QTOF-MS showed the presumptive presence of at least one non-FDA approved benzodiazepine in 30/35 specimens: flubromazolam (12/35), flualprazolam (11/35), flubromazepam (2/35), clonazolam (4/35), etizolam (9/35), metizolam (5/35), nitrazepam (1/35), and pyrazolam (1/35). Two or three designer benzodiazepines were detected concurrently in 13/35 specimens. Qualitative LC-MS/MS confirmed the presence of at least one designer benzodiazepine or metabolite in 23/35 specimens, with 3 specimens unavailable for confirmatory testing. Urine benzodiazepine screening assays from three manufacturers were cross-reactive with multiple non-US FDA-approved benzodiazepines. Clinical and forensic toxicology laboratories using traditionally designed LC-MS/MS panels may fail to confirm the presence of non-US FDA-approved benzodiazepines detected by screening assays, risking inappropriate interpretation of screening results as false-positives.

R v Westwood (Thomas): diminished responsibility and disposals under the Mental Health Act 1983

2021 ◽  
Vol 72 (2) ◽  
Author(s):  
Sean Mennim
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
England And Wales ◽  
Mental Health Act ◽  
Court Of Appeal ◽  
Diminished Responsibility

This is a commentary on R v Westwood (Thomas), where the Court of Appeal of England and Wales held that the judge had erred in assessing Westwood’s ‘retained responsibility’ as medium to high under the Sentencing Council Guideline for manslaughter by reason of diminished responsibility. Although the sentencing judge concluded that the offending was caused by Westwood’s anger, the Court of Appeal found the psychiatric evidence clearly indicated that the most significant factor was Westwood’s mental illness and that his anger at the time of the offence was a manifestation of his mental illness. Westwood’s responsibility was low, and it was appropriate to impose both a hospital and restriction order.  

Racial and Ethnic Differences in Urine Drug Screening on Labor and Delivery

2022 ◽  
Author(s):  
Mae-Lan Winchester ◽  
Parmida Shahiri ◽  
Emily Boevers-Solverson ◽  
Abigail Hartmann ◽  
Meghan Ross ◽  
...  
Keyword(s):  
Ethnic Differences ◽  
Drug Screening ◽  
Labor And Delivery ◽  
Racial And Ethnic Differences ◽  
Urine Drug ◽  
Urine Drug Screening
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