The care of patients using methamphetamine in the emergency department: Perception of nurses, residents, and faculty

ABSTRACT

Background: To determine differences in perception between nurses, residents, and faculty regarding characteristics and treatment of patients who use methamphetamine (meth). Methods: Survey study performed at an urban, university Level I trauma medical center. Results: A total of 80 nurses, 39 residents, and 45 faculty completed the survey. All groups agreed that meth was a significant problem nationwide and in our emergency department (ED). Nurses estimated that 33% of their patients used meth, which differed from residents (18%) and faculty (15%). All agreed that these patients required more effort to care for, utilized more hospital resources, and were more often violent toward staff. Nurses reported higher prevalence of actual assault by patients using meth (70%) than did residents (36%) and faculty (47%), and total lifetime number of assaults. All agreed that patients using meth appropriated prehospital resources at a higher rate than nonusers, had a higher rate of recidivism, and longer ED length of stay. Nurses preferred antipsychotics over benzodiazepines for treatment of meth-induced tachycardia and a lower threshold for treatment of associated hypertension than residents and faculty. For treatment of hypertension, nurses preferred beta-blockers and hydralazine over benzodiazepines. Conclusion: All agreed that meth use is a serious problem in our ED, with high resource utilization, recidivism, and violence against staff. Nurses experienced higher rates of assaults by patients using meth and differed with regard to their disposition and treatment. Treatment guidelines, strategies to mitigate violence towards staff, and interprofessional education may be beneficial, as the stakes of caring for these patients are high and preferences vary between caregivers.

KEYWORDS:

• Agitation
• assault
• emergency
• hypertension
• methamphetamine
• nursing
• tachycardia
• toxicity
• violence

Author contributions

J.A.H. conceived of the project under the mentorship of J.R.R. and advising from E.W.A. and E.G.L. J.R.R. and J.A.H. designed the survey instruments, obtained institutional review board approval, distributed and collected the surveys, and recorded the results. Statistical analysis was performed by J.R.R. and J.A.H. The manuscript was prepared by J.R.R. with help from J.A.H., E.W.A., and E.G.L. All authors participated in editing and revising the manuscript. All of the listed authors meet the requirements for authorship per the Uniform Guidelines for Biomedical Journals Requirements of the International Committee of Medical Journal Editors (ICMJE) for determining authorship (Vancouver Group Guidelines, 2010). No other individuals meet these guidelines for authorship.