Top 10 Tips to Ensure a Safe Environment of Care for Detox Patients

What happens when someone with an addiction decides to stop using drugs or alcohol? The process of detoxification or “detox,” clearing the body of these harmful substances, can be dangerous and painful if done without medical supervision.

Drug and alcohol abuse has become a serious threat nationwide, increasing the risk of life-threatening self-detox. In Louisiana, opioid deaths increased by 25% from 470 to 588 in 2019. During the first year of the COVID-19 pandemic, the CDC reported that overdose deaths from opioids in Louisiana rose 56% from March 2020 – March 2021.

Detox is different for every person, and the length and degree of withdrawal symptoms will vary depending on numerous factors, such as the type of substance being abused, duration of the addiction, family history, and other co-morbidities. Detox patient care is often available at most major medical facilities, along with in-patient rehabilitation centers.

Potential Adverse Effects of Drug & Alcohol Detox

Without proper medical supervision, a person who suddenly quits substance abuse could suffer from serious issues that may affect them physically, emotionally, or mentally. These side effects make medical supervision critical for a safe detox process.

Physical Side Effects

Headaches and Migraines: These can occur due to dehydration, electrolyte imbalances, or withdrawal from stimulants.
Nausea: Especially common in opioid and alcohol detox, nausea and vomiting may occur due to the body's response to the absence of certain chemicals.
Sweating and Shaking: As the nervous system adjusts to lowered amounts of substances, excessive sweating and body shakes can occur, especially during alcohol or benzodiazepine detox.
Muscle Pain and Cramps: Often caused by withdrawal from opioids or stimulants, muscles may become sore or spasm in response.
Fatigue or Insomnia: Detox patients can experience both a lack of energy or difficulty sleeping as their body readjusts to its natural rhythm.
Flu-like Symptoms: Detox patients may experience symptoms such as chills, runny nose, and general malaise.
Increased Heart Rate and Blood Pressure: This is often seen in alcohol and stimulant withdrawal, which could pose a risk of more serious complications like seizures or cardiac issues in certain patients.

Psychological & Emotional Side Effects

Anxiety & Irritability: These are common traits that may appear as the body readjusts to functioning without certain substances.
Depression: Drastic mood swings and depressive symptoms can occur, particularly with opioid and stimulant withdrawal.
Restlessness: Patients may be on edge or unable to relax due to nervous system adjustments.
Hallucinations & Delusions: These symptoms are often seen in severe alcohol withdrawal and with certain drugs like hallucinogens or high-dose stimulants.
Drug & Food Cravings: Patients may exhibit intense cravings as the brain’s reward system begins seeking the substance or other “rewards” in its absence.

Severe Withdrawal Effects

Delirium Tremens (DTs): This is a severe condition that occurs during alcohol withdrawal that produces confusion, rapid heart rate, and hallucinations. DTs are a medical emergency and can be life-threatening if not treated properly.
Suicidal Ideation: During withdrawal from certain substances, some individuals may experience severe mood changes which may prompt thoughts of suicide.
Paranoia or Psychosis: Often seen in stimulant withdrawal, these psychological symptoms can manifest as extreme paranoia or temporary psychotic episodes, which could lead the patient to harm themselves or others.

The Role of Medical Support in Safe Patient Detox

Considering the range of symptoms and severity that can occur, detox is only the beginning of treatment for affected individuals. Ongoing professional supervision and support are necessary to ensure that individuals safely pass the detox phase and do not fall back into their addiction.

Medical support during detox goes beyond merely managing symptoms. It provides a comprehensive approach to withdrawal management that encompasses medication-assisted treatment (MAT), psychological support, and coordination of care. Here are some key aspects of medical support in detox:

Medication-Assisted Treatment (MAT)

MAT involves the use of medications such as methadone, buprenorphine, or naltrexone for opioid detox and benzodiazepines or anticonvulsants for alcohol detox. These medications help manage withdrawal symptoms, reduce cravings, and prevent complications.

Monitoring and Stabilization

Medical staff monitor vital signs, hydration levels, and mental health status throughout the detox process. This allows for timely intervention in case of emergencies, ensuring that patients remain stable and comfortable.

Psychological Support and Counseling

Detox can be emotionally challenging, as individuals may experience anxiety, depression, or intense cravings. Medical professionals and counselors provide psychological support and coping strategies to address these issues and reduce the risk of relapse.

Transition to Ongoing Treatment

Successful detox is just the beginning. Without proper follow-up care, the risk of relapse is high. Medical support staff facilitate a smooth transition from detox to a structured inpatient or outpatient program, where individuals receive comprehensive therapy and behavioral support.

Short-Term Detox Programs and Hospital Partnerships

To address the growing need for accessible detox services, many hospitals have established short-term detox and withdrawal management programs. These programs are typically designed for patients who require immediate medical intervention to manage severe withdrawal symptoms but are not yet ready or able to enter a long-term treatment program.

Hospitals frequently collaborate with specialized withdrawal management organizations or addiction treatment centers. This collaboration allows hospitals to offer a continuum of care, ensuring that patients receive medical detox services in a hospital setting and then transition to specialized addiction treatment facilities for ongoing rehabilitation and support.

Benefits for Detox Patients:

Comprehensive Medical Care: Hospital-based programs can address complex medical needs and co-occurring disorders, such as mental health issues or chronic illnesses, that often accompany addiction.
Integrated Care Models: Partnerships with addiction treatment centers enable seamless care coordination, improving patient outcomes through integrated treatment plans.
Access to Specialty Care: Hospitals have access to a broader range of healthcare professionals and specialists, which can be vital for patients experiencing severe withdrawal symptoms or those with high-risk medical conditions.

Recommendations for Delivering Safe Care During Withdrawal Management

To ensure a therapeutic, safe environment of care and a positive detox experience for the patient, the hospital should put proactive measures in place. If your healthcare facility is providing or plans to provide this type of service, consider these recommendations:

Secure Medications: It’s important to ensure all medications are secure from unauthorized access to narcotics, sedatives, and other addictive substances.
Control Contraband: Have a hospital policy and process in place to limit entering materials including any contraband that could compromise your detox environment.
Manage Visitation: You can allow family members to visit, but encourage limited visitation to promote rest and minimization of withdrawal symptoms. Request that visitors do not bring in any personal items such as a purse or bag when visiting the patient. This would limit the chance of families bringing in items that could prevent the patient from having a successful detox experience.
Monitor Visitation: By providing a comforting visitation area where patients, visitors, and family members can visit out in the open instead of in the patient’s room, you can observe the patient during these encounters to ensure nothing interferes with their recovery. This also would allow the patient to have a change of scenery during their detox experience instead of staying in the hospital room all the time.
Invest in Violence Intervention Training: Ensure all staff is trained in identifying and de-escalating violence techniques in the event the patient experiences agitation or aggression during the detox process.
Prioritize Peace: Offer the patient a room in a quiet designated area to limit the amount of foot traffic and noise that occurs in the hospital. This would help to promote a therapeutic environment for care and treatment.
Set Designated Caregivers: By having a designated group of caregivers who are trained in the withdrawal management & detox process providing care for each patient, you can build trust and enhance comfort for the patient.
Enforce Smoking Policies: If the hospital does not allow smoking and the patient requests to smoke, contact the physician for orders to provide other measures to address their smoking needs.
Maintain Safe Walkways: Encourage staff to keep hallways and rooms free of any slip, trip, or fall hazards.
Uphold Hospital Safety Regulations: Ensure all hospital policies are adhered to concerning the safety and security of all patients, visitors, and staff. Have security conduct rounds on the unit as an extra level of security for all patients.

By proactively implementing the measures listed above, the organization would be promoting a safe and secure environment of care for patients.

Partnering with Third-Party Providers? Pay Attention to the Details

Your organization also needs to take care to limit liability when signing a contract with a third party for these services. The hospital should be indemnified fully by the company managing the program, or at least an indemnity protecting each party from liability for the other’s negligence should be included.

In connection with the contractual agreement, the contract company should be insured for all claims arising from the program’s existence at the hospital premises and provide proof of coverage. Coverage should extend for the contract company employees’ claims, patient claims, and visitor claims for personal injury. There should also be coverage for premises liability.

Need More Resources?

If you have concerns related to the contract, please contact LHA Trust Funds to discuss the language with one of our claims specialists who are ready to assist you.

Access the Opioid Management, Environment of Care, and Medication Safety toolkits to gain greater resources to implement into your organization’s best practices today.

About the Authors

Stacie Jenkins, RN, MSN, CPSO
Vice President of Patient Safety and Risk, LHA Trust Funds

Stacie Jenkins is a registered nurse with a master’s degree in nursing informatics. She has more than 20 years’ experience in healthcare, working in patient care and quality/performance improvement positions. As the Vice President of Patient Safety & Risk at LHA Trust Funds, she works closely with hospital administrators, risk managers and nursing staff to improve patient safety and establish best practices. She conducts on-site assessments and gives presentations designed to help clients address their patient safety risk management challenges.

Caroline Stegeman, RN, BSN, MJ, ONC, CPHRM, CPSO
Director of Patient Safety, LHA Trust Funds

Caroline Stegeman has 28 years of nursing and clinical risk management experience in a variety of healthcare settings. She has extensive experience in the management and handling of patient safety issues/ incidents, clinical and environmental risk assessments, root cause analysis, regulatory and industry best practices (TJC, CMS, DHH), hospital emergency preparedness and disaster management, and quality improvement initiatives.