Relationships, collaboration, and engagement are central to effective integrated care services, ensuring that patients living with life-threatening addictions obtain the correct diagnosis and support whilst in hospital care.
Doctors based in Bristol demonstrated how a joined-up approach successfully transformed the experience for one patient who was presenting acute and complex issues living with drug addiction, while also supporting hospital staff who were facing difficulties managing and engaging with the patient.
The patient, who was receiving dialysis at the Renal (Kidney) Unit at North Bristol NHS Trust, and prescribed methadone as part of his drug recovery treatment; had become critically ill after missing several dialysis treatments and was admitted to the Intensive Care Unit. During this process, it also became clear that his prescription needed to be altered.
Dr Alia Medniuk, a Consultant in Anaesthesia and Pain Medicine and Acute Pain Service Lead at Southmead Hospital in Bristol along with Dr Ben Watson who is a Consultant Addiction Psychiatrist with Avon and Wiltshire Mental Health Partnership NHS Trust and is the Clinical lead for Bristol ROADS (the commissioned drug and alcohol treatment system), worked together after they each were individually approached by staff at the Renal Unit where the patient was receiving care.
“The Renal Unit didn’t have established links to a drugs liaison team and had reached a crisis point in their struggle to deal with the patient who had become increasingly hostile and anti-social,” explained Dr Watson, “so they approached me and Dr Medniuk individually for advice. While they could care for him from a renal perspective, they didn’t have the clinical expertise onsite to manage the patient’s methadone prescription and were also struggling with his challenging behaviour.”
When the two doctors met on Microsoft Teams to map out the treatment process it became evident that a collaborative approach embracing the addiction treatment expertise in tandem with the other healthcare specialists, while placing the patient at the centre of the discussion was needed. During the meeting Dr Watson provided specialist advice, allowing Dr Medniuk to make informed changes to the patient's medication. This example of collaborative working proved to be hugely successful as the team were then able to achieve the best possible outcome for the patient.
“Dr Medniuk was the hero here, she took decisive action by successfully liaising with the patient’s GP and the Renal Unit staff, changing the patient’s medication and, critically, took the time to sit down with the patient and explain what was happening. It worked very well.”
“Dr Medniuk had the right approach and understanding to bring together the various departments and professionals in a pragmatic way,” explained Dr Watson, “and the outcome was not only providing the enhanced and joined up care that was needed, but also helped to calm the patient and ensure the best outcome for him.”
Because Dr Medniuk took the time to sit with the patient and explain his options, he quickly settled and could engage in an open conversation. “His anti-social behaviour was sparked by misunderstanding and driven by fear,” Dr Medniuk recalled, “but through chatting with him I could connect with him as an individual, not just a perceived difficult patient, and put him at ease while also reassuring the hospital staff dealing with him.”
Listening to the patient who has experience of living with their condition and ensuring that they are supported while healthcare professionals use their clinical and specialist expertise is at the heart of this collaborative approach, and one that both Dr Watson and Dr Medniuk have long worked on and advocate in the addictions treatment sector.
Forging relationships with other professionals in the sector on a pro-bono basis along with the ability to involve the patient in a compassionate way, are important considerations and key to resolving the most difficult issues and experiences.
“Healthcare is fundamentally based on relationships,” Dr Watson commented, “along with goodwill and common sense. It can be as simple as meeting for a coffee with a colleague from another clinical or service department within or between organisations, as long as a real working connection is formed that is clinically-led but backed up with an operational approach."
“In this case, the positive outcome wouldn’t have happened without Dr Medniuk’s brave and decisive approach. She used her clinical expertise to adjust his medication, and her communication skills to break the fear that both the patient and the hospital staff were experiencing. It clearly demonstrates what is possible and how a joined-up approach can work.”
It is this collaborative approach that benefits people with complex health and care needs, particularly those living with drug and alcohol addiction, and clearly highlights the requirement for specialist addictions support in a hospital setting.