Substance use amongst inpatients on mental health wards: practical guide for mental health services

Guidance for NHS health boards providing inpatient mental health services on responding to substance use on mental health wards. This should be used in conjunction with existing local guidance for responding to substance use incidents on inpatient wards.

13. Appendix A – Flowchart for patient under the influence of substances

When a patient is under the influence (or suspected to be under the influence) of substances, they should be asked to remain on the ward for further assessment. If they do not agree to this, staff should conduct a risk assessment of the situation, an assessment of the patient’s capacity and if necessary, use appropriate legislation to ensure the patient’s safety (this may include the use of common law in an emergency). Staff should follow specified persons guidance when undertakin g searches of a patient’s property and person.

Text version below image

Flowchart text version:

Stage 1

  • Patient intoxicated

Stage 2

  • Keep someone with the patient until an assessment of risk can be undertaken

Stage 3

  • Check clinical observations and record on NEWS Chart, escalating and monitoring as directed

Stage 4

  • Consider:
    • What substance was taken
    • When it was taken
    • Underlying health conditions
    • Physical frailty or obesity
  • Undertake a search of the patient and their belongings

Stage 5

  • If patient does not consent, consider the need for police assistance

Stage 6

  • If patient does consent, breathalyse the patient.
  • If the patient refuses, document this in the notes and notify the doctor/ANP

Stage 7

  • Request and undertake a drug screen.
  • If the patient refuses, document this in the notes and notify the doctor/ ANP

Stage 8

  • Advise the patient that they no longer have time off the ward and amend all necessary documentation

Stage 9

  • Review with the Duty Doctor/ ANP or Ward Doctor/ANP

Stage 10

  • Determine if it is safe for the patient to receive routine medicines or if these should be withheld

Stage 11

  • Discuss with the Consultant

Stage 12

  • The team should undertake a clinical pause to formulate a management plan



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