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Zagorski CM, Hosey RA, Moraff C, Ferguson A, Figgatt M, Aronowitz S, Stahl NE, Hill LG, McElligott Z, Dasgupta N. Reducing the harms of xylazine: clinical approaches, research deficits, and public health context. Harm Reduct J 2023; 20:141. [PMID: 37777769 PMCID: PMC10544173 DOI: 10.1186/s12954-023-00879-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES Xylazine has emerged as a consistent part of the unregulated drug supply in recent months. We discuss major domains of xylazine's harm, current knowledge deficits, clinical and harm reduction strategies for minimizing harm, and xylazine's public health and policy context. As an interdisciplinary team from across the USA, we have pooled our knowledge to provide an overview of xylazine's current and emerging contexts. METHODS To inform this essay, the pertinent literature was reviewed, clinical knowledge and protocols were shared by multiple clinicians with direct expertise, and policy and public health context were added by expert authors. RESULTS We describe xylazine's major harm domains-acute poisoning, extended sedation, and wounds, along with anemia and hyperglycemia, which have been reported anecdotally but lack as clear of a connection to xylazine. Current successful practices for xylazine wound care are detailed. Understanding xylazine's epidemiology will also require greater investment in drug checking and surveillance. Finally, approaches to community-based wound care are discussed, along with an orientation to the larger policy and public health context. CONCLUSIONS Addressing the harms of xylazine requires interdisciplinary participation, investment in community-based harm reduction strategies, and improved drug supply surveillance. The relatively unique context of xylazine demands buy-in from public health professionals, harm reduction professionals, clinicians, basic science researchers, policymakers and more.
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Affiliation(s)
- Claire M Zagorski
- College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1910, PHR 3.208J, Austin, TX, 78712, USA.
| | - Rebecca A Hosey
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4000, Philadelphia, PA, 19104, USA
| | | | - Aaron Ferguson
- National Survivors Union, 1116 Grove St, Greensboro, NC, 27403, USA
| | - Mary Figgatt
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Shoshana Aronowitz
- University of Pennsylvania School of Nursing, Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Natalie E Stahl
- Greater Lawrence Family Health Center, 34 Haverhill Street, Lawrence, MA, 01841, USA
| | - Lucas G Hill
- College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1910, PHR 3.208J, Austin, TX, 78712, USA
| | - Zoe McElligott
- Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina, CB#7178, 104 Manning Road, Chapel Hill, NC, 2759, USA
| | - Nabarun Dasgupta
- University of North Carolina, 725 MLK Jr. Blvd., CB 7505, Chapel Hill, NC, 27599, USA
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Coleman S, Nelson EA, Vowden P, Vowden K, Adderley U, Sunderland L, Harker J, Conroy T, Fiori S, Bezer N, Holding E, Atkin L, Stables E, Dumville J, Gavelle S, Sandoz H, Moore K, Chambers T, Napper S, Nixon J. Development of a generic wound care assessment minimum data set. J Tissue Viability 2017; 26:226-240. [DOI: 10.1016/j.jtv.2017.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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Gillespie BM, Chaboyer W, Kang E, Hewitt J, Nieuwenhoven P, Morley N. Postsurgery wound assessment and management practices: a chart audit. J Clin Nurs 2014; 23:3250-61. [DOI: 10.1111/jocn.12574] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Brigid M Gillespie
- NHMRC Research Centre for Clinical Excellence in Nursing Interventions (NCREN); Centre for Healthcare Practice Innovation (HPI); Griffith Health Institute; Griffith University; Gold Coast Qld Australia
| | - Wendy Chaboyer
- NHMRC
Centre of Research Excellence in Nursing Interventions (NCREN); Centre for Healthcare Practice Innovation (HPI); Griffith Health Institute; Griffith University; Gold Coast Qld Australia
| | - Evelyn Kang
- NHMRC Research Centre for Clinical Excellence in Nursing Interventions (NCREN); Centre for Healthcare Practice Innovation (HPI); Griffith Health Institute; Griffith University; Gold Coast Qld Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery; PhD Candidate Griffith Law School; Griffith University; Gold Coast Qld Australia
| | - Paul Nieuwenhoven
- Division of Surgery Services; Gold Coast University Hospital; Gold Coast Health Service
District; Gold Coast Qld Australia
| | - Nicola Morley
- Vascular Services; Gold Coast University Hospital; Gold Coast Health Services District; Gold Coast Qld Australia
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Jefferies D, Johnson M, Nicholls D, Langdon R, Lad S. Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned. Int Nurs Rev 2012; 59:394-401. [DOI: 10.1111/j.1466-7657.2012.00994.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Jefferies
- School of Nursing and Midwifery, Centre for Applied Nursing Research (Joint Facility of SSWAHS & the University of Western Sydney), College of Health & Science, University of Western Sydney, Sydney, NSW, Australia.
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Wound assessment. Plast Surg Nurs 2009; 29:128-30. [PMID: 19528783 DOI: 10.1097/01.psn.0000356873.48714.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wound assessment, combined with a thorough patient history, is the foundation for developing a plan of care and for assessing its efficacy. A wound assessment will enable the clinician to determine whether the wound is infected, needs surgical intervention, and what modality of treatment is necessary. In clinical practice, wound assessment remains the only way to determine whether the wound is progressing and moving to the desired goal of care. This article will present the implications and fundamentals of an accurate wound assessment.
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Törnvall E, Wahren LK, Wilhelmsson S. Advancing nursing documentation--an intervention study using patients with leg ulcer as an example. Int J Med Inform 2009; 78:605-17. [PMID: 19447071 DOI: 10.1016/j.ijmedinf.2009.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 10/19/2008] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
AIM The aim was to implement and evaluate a standardised nursing record, using patients with leg ulcer as an example, regarding the content of the nursing record and district nurses' experiences of documentation. METHOD This was a prospective, stratified and randomised intervention study, with one intervention group and one control group. A standardised nursing wound care record was designed and implemented in the electronic patient record in the intervention group for a period of 3 months. Pre- and post-intervention audits of nursing records [n=102 and n=92, respectively] were carried out and 126 district nurses answered questionnaires pre-intervention and 83 post-intervention. RESULT The standardised nursing wound care record led to more informative, comprehensive and knowledge-intensive documentation according to the audit and district nurses' opinions. Furthermore, the district nurses' self-reported knowledge of nursing documentation increased in the intervention group. When the standardised nursing wound care record was not used, the documentation was mostly incomplete with a lack of nursing relevance. There were no differences in the district nurses' experiences of documentation in general between the two groups. CONCLUSION Using the standardised nursing wound care record improved nursing documentation meeting legal demands, which should increase the safety of patient. There was however a discrepancy between the nurses stated knowledge and how they carried out the documentation. Regular in-service training together with use of evidence based standardised nursing records, as a link to clinical reasoning about nursing care, could be ways effecting change.
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Affiliation(s)
- Eva Törnvall
- Department of Social and Welfare Studies, Faculty of Health Sciences, University of Linköping, Campus Norköping, SE 60174 Norrköping, Sweden.
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Abstract
AIMS To investigate the utility of electronic nursing documentation by exploring to what extent and for what purpose general practitioners use nursing documentation and to what extent and in which cases care unit managers use nursing documentation for quality development of care. BACKGROUND As health care includes multidisciplinary activities, communication about the care given is essential. To assure delivery of good and safe care, quality development is necessary. The main tool available for communication and quality development is the patient record. In many studies, nursing documentation has been found to be inadequate for this purpose. DESIGN This study had a cross-sectional descriptive design. METHODS Data were collected by postal questionnaires, one to the general practitioners (n = 544) and one to care unit managers (n = 82) in primary health care. Data were analysed by descriptive statistical and qualitative content analysis. RESULTS The general practitioners usually used the nursing record as the foremost source of information for treatment follow-up. The results, however, point out weaknesses and shortcomings in the nursing records, such as difficulties in finding important information because of a huge amount of routine notes. The care unit managers generally (74%) used the record for statistical purposes, while only half of them used it to evaluate care. CONCLUSION Nursing records need more clarity and need to be more prominent regarding specific nursing information to fulfil their purpose of transferring information and to constitute a base for quality development of care. RELEVANCE TO CLINICAL PRACTICE The results of this study can provide a part of a basis upon which a multi-professional patient record could be developed and which could also function as an alarm to managers at different levels to prioritize the development of nursing documentation.
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Affiliation(s)
- Eva Törnvall
- Department of Social and Welfare Studies, Faculty of Health Sciences, University of Linköping, Norrköping, Sweden.
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Abstract
Wound healing is a complex interchange, orchestrated between cellular components that play their respective parts signaled by and mediated by different cellular instruments of healing. When healing is performed well, the final product is a thing of beauty. When healing is delayed, interrupted, or excessive, then unsightly scars of chronic painful wounds that are frustrating to the patient and physician occur.
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Affiliation(s)
- Margaret K Strecker-McGraw
- Department of Emergency Medicine, Scott and White Hospital, Texas A&M University College of Medicine, 2401 S. 31st Street, Temple, TX 76504, USA.
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