Program Helps Patients with Substance Use Disorder

Podcast Transcript

Carol Pehotsky (00:00):

For patients with substance use disorder, being in that judgment-free zone is so very important for the nurse to portray. I'm joined today by Jonathan Sanchez to learn more about how nurses can meet patients where they're at and perhaps help them get on the road to recovery.

(00:23):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing. Welcome back, everyone. You know, I once heard it said that just about every family is some way, shape, or form impacted substance use. And just because you don't know it doesn't mean it's not true.

(00:56):

So in preparing for today's episode, I did a little investigation to see how s- true that statement might be and found myself look at some data from Substance Abuse and Mental Health Services Administration of the government. In 2023, it was shown that at least 48.7 million people, or 17.1% of the US population alone has some form of substance use disorder. And the news doesn't get any better from there in terms of heartbreak. Uh, looking at people who identified as having this disorder but not having treatment, the numbers continue to grow including demographics of 12 to 17-year-olds. 1.8 million of those kiddos did not receive treatment because 1.6 of them didn't think they needed to.

(01:36):

And, you know, back in the day, it was called addiction, and the language has changed. And hopefully part of that is because we all do need to realize that as nurses and as human beings, it's something we need to be thoughtful about and sensitive to, and help get patients to the right resources just like we would any other disorder. So with that, it's my genuine pleasure to introduce you all to Jonathan Sanchez. Jonathan is the nurse manager of the Akron General Emergency Department here within Cleveland Clinic system, and also has been the spearhead of this great program. Before we get into that, though, I'd love for you to tell us a little bit about your career journey so far, Jonathan, and what has you passionate about this topic?

Jonathan Sanchez (02:14):

Yeah. Thank you for having me. I've been at Akron General for roughly close to 18 years now.

Carol Pehotsky (02:14):

Oh, wow. All right.

Jonathan Sanchez (02:20):

Um, started off as a critical care nurse, got into emergency nursing actually through, as a leader, yeah, under the guidance of a previous leader thought I had-

Carol Pehotsky (02:29):

Nice.

Jonathan Sanchez (02:30):

... had it. And-

Carol Pehotsky (02:30):

Here you are (laughs).

Jonathan Sanchez (02:30):

... I took a shot, and 11 years later, I'm still doing it-

Carol Pehotsky (02:31):

Oh, wow. All right.

Jonathan Sanchez (02:34):

... and enjoying it very much.

Carol Pehotsky (02:36):

Excellent.

Jonathan Sanchez (02:36):

And when it comes to those who suffer from substance use disorder or addiction-

Carol Pehotsky (02:40):

Mm-hmm.

Jonathan Sanchez (02:40):

... over the past 11 years as the emergency nurse leader, you see the impact that this has-

Carol Pehotsky (02:46):

Oh, sure.

Jonathan Sanchez (02:46):

... on the community-

Carol Pehotsky (02:47):

Yeah.

Jonathan Sanchez (02:47):

... and the amount of patients that come in to the emergency departments. And they're suffering whether it's from a drug or-

Carol Pehotsky (02:47):

Mm-hmm.

Jonathan Sanchez (02:54):

... alcohol.

Carol Pehotsky (02:54):

Mm-hmm.

Jonathan Sanchez (02:55):

But they need help, they wanted help, they were seeking help.

Carol Pehotsky (02:57):

Sure.

Jonathan Sanchez (02:58):

But we were unable to give it.

Carol Pehotsky (03:00):

Yeah, okay.

Jonathan Sanchez (03:00):

And so this is... Once the opportunity arose, I jumped on it.

Carol Pehotsky (03:04):

Well, we'll get into the details of this amazing program in a moment. I want to spend a little more time first sorta talking about the background and the depth and breadth of substance use disorder. So, you know, as I'd mentioned at the beginning, th- noticing that the language has changed, can you share a little bit more with our audience about that transition from the use of the word addiction to-

Jonathan Sanchez (03:04):

Mm-hmm.

Carol Pehotsky (03:25):

... substance use disorder?

Jonathan Sanchez (03:26):

The word addiction, or to be an addict-

Carol Pehotsky (03:31):

Mm-hmm.

Jonathan Sanchez (03:31):

... adds a negative connotation to it.

Carol Pehotsky (03:31):

Sure.

Jonathan Sanchez (03:31):

And it was more taboo to say that. So now that we know medically that addiction is now a chemical makeup within the brain, and it is a diagnosable disorder.

Carol Pehotsky (03:40):

Mm-hmm.

Jonathan Sanchez (03:41):

And, and so that the new term is substance use disorder-

Carol Pehotsky (03:41):

Okay.

Jonathan Sanchez (03:44):

... and those who suffer from that.

Carol Pehotsky (03:46):

And we've all experienced that, I'm sure. Hopefully haven't felt it, but, you know, unfortunately sometimes in the culture, that's the gut reaction.

Jonathan Sanchez (03:46):

Mm-hmm.

Carol Pehotsky (03:54):

So knowing that we have nurses that are all the way from just in nursing school to nurses who, it used to be called addiction and that's their vernacular-

Jonathan Sanchez (04:03):

Hm.

Carol Pehotsky (04:04):

... what advice would you give for nurses to work through, like, checking that judgment at the door and really meeting patients where they're at?

Jonathan Sanchez (04:10):

That has to go with the stigma part of it.

Carol Pehotsky (04:10):

Yeah.

Jonathan Sanchez (04:12):

And stigma plays a large role in this topic. And understanding that this is a disorder-

Carol Pehotsky (04:12):

Yeah.

Jonathan Sanchez (04:19):

... and that, yes, these patients may have that initial choice to initiate it-

Carol Pehotsky (04:19):

Mm-hmm.

Jonathan Sanchez (04:26):

... but the progression as a disease-

Carol Pehotsky (04:28):

Yeah.

Jonathan Sanchez (04:28):

... progresses, they don't have that choice anymore. It is biologic.

Carol Pehotsky (04:32):

Sure.

Jonathan Sanchez (04:32):

Th- they, they have that need for it. So having that understanding of the disease process-

Carol Pehotsky (04:37):

Hm, mm-hmm.

Jonathan Sanchez (04:37):

... and it shows respect for that, then I think it's easier for them to say, "This is a substance use disorder.

Carol Pehotsky (04:44):

Sure.

Jonathan Sanchez (04:44):

These people suffer from it," as opposed to calling them an addict.

Carol Pehotsky (04:47):

Well, and it's just so pervasive in our society.

Jonathan Sanchez (04:50):

Hm.

Carol Pehotsky (04:50):

You know, if somebody turns down a drink at a party, people are assuming if they're a woman that they're pregnant, or, "Why? What's wrong with you," or-

Jonathan Sanchez (04:50):

Yes.

Carol Pehotsky (04:57):

... "Come on, just have one."

Jonathan Sanchez (04:58):

Yes. And unfortunately, that's how our society is-

Carol Pehotsky (04:58):

Yeah.

Jonathan Sanchez (05:00):

... is if you're not partaking in, you just mentioned, of, at a party and having a drink, it's okay to say no-

Carol Pehotsky (05:07):

Mm-hmm.

Jonathan Sanchez (05:07):

... or to pass on that stuff because they know why they're doing it-

Carol Pehotsky (05:07):

Right.

Jonathan Sanchez (05:11):

... and we, as in other individuals, shouldn't be-

Carol Pehotsky (05:14):

Yeah.

Jonathan Sanchez (05:14):

... pressuring them-

Carol Pehotsky (05:14):

Yup.

Jonathan Sanchez (05:15):

... in no fashion at all.

Carol Pehotsky (05:16):

Nope. So appreciating that, you know, as nurses, we want to really set that bar high when it comes to meeting our patients where they're at and making sure that we're not participating in that stigma. What's some advice you have for nurses who absolutely want to meet the patients where they're at, they don't want to be judgmental, how can they comfortably discuss substance use disorder and even possibly recovery options without inserting any of that language?

Jonathan Sanchez (05:40):

It really is reaching out to those resources that are out there within the medical community or nursing community, especially at your local hospitals. So like any nurse, if you don't know, ask.

Carol Pehotsky (05:51):

That's right, yeah.

Jonathan Sanchez (05:52):

'Cause the resources are out there, and the-

Carol Pehotsky (05:53):

Mm-hmm.

Jonathan Sanchez (05:53):

... experts are out there. Uh, reaching out so that you become versed yourself-

Carol Pehotsky (05:57):

Mm-hmm.

Jonathan Sanchez (05:57):

... so when you have the opportunity to approach a patient that may suffer, then you can have that conversation so it's meaningful towards that patient, but also meaningful to that nurse.

Carol Pehotsky (06:07):

Sure, yeah. Well and, and you think about it, in so many phases of nursing, it's so important to, to establish trust pretty quickly. I come from a surgical area, right?

Jonathan Sanchez (06:08):

Mm-hmm.

Carol Pehotsky (06:16):

So, you know, being able to have a patient feel comfortable enough around me that they can be honest with me that day of surgery, did they consume any substances?

Jonathan Sanchez (06:25):

Mm-hmm.

Carol Pehotsky (06:25):

When was the last time they did? What truly did they consume? W- what the amount is so we can make sure we deliver safe care to that patient-

Jonathan Sanchez (06:25):

Correct.

Carol Pehotsky (06:32):

... through that surgical journey. Any advice around that? You know, we, we need to get to the truth. We don't want to be judgmental. We're setting up this rapport with the patient, and it really is so very important that we get a very honest answer.

Jonathan Sanchez (06:44):

Yes. And trust is a major part of this.

Carol Pehotsky (06:46):

Mm-hmm.

Jonathan Sanchez (06:48):

Of talking with patients in past, they believe if they're gonna tell you about their substance-

Carol Pehotsky (06:48):

Mm-hmm.

Jonathan Sanchez (06:53):

... use disorder or their addiction, it really is because they think that you're gonna turn them in-

Carol Pehotsky (06:57):

Sure.

Jonathan Sanchez (06:58):

... to local authorities.

Carol Pehotsky (06:58):

Yeah.

Jonathan Sanchez (06:58):

Yeah. And-

Carol Pehotsky (07:00):

"Are you gonna not do my surgery if I tell you that I-"

Jonathan Sanchez (07:01):

Correct, yeah.

Carol Pehotsky (07:02):

Mm-hmm.

Jonathan Sanchez (07:02):

And it's, it's really gaining that trust from the s- to understand, you know, uh, we respect your decision to what you've done-

Carol Pehotsky (07:09):

Mm-hmm.

Jonathan Sanchez (07:09):

... this far, but we need to take care of you properly-

Carol Pehotsky (07:12):

Sure.

Jonathan Sanchez (07:12):

... because whatever you may have injected-

Carol Pehotsky (07:14):

Mm-hmm.

Jonathan Sanchez (07:14):

... ingested, or smoked-

Carol Pehotsky (07:16):

Mm-hmm.

Jonathan Sanchez (07:17):

... may have consequences if we now start to provide care to you-

Carol Pehotsky (07:17):

Right.

Jonathan Sanchez (07:21):

... and medication. So we need to know these things so we can provide proper care.

Carol Pehotsky (07:25):

So let's turn back to this great program we've been alluding to. So can you tell our audience a little bit more about the Recovery In Reach program?

Jonathan Sanchez (07:32):

So Recovery's In Reach is a recovery-based program out of Akron General's Emergency Department.

Carol Pehotsky (07:32):

Mm-hmm.

Jonathan Sanchez (07:38):

So it supports the main Akron General Emergency Department, but also out freestanding emergency departments-

Carol Pehotsky (07:38):

Oh, great, okay.

Jonathan Sanchez (07:42):

... at Stow, PATH, and Green.

Carol Pehotsky (07:44):

Mm-hmm.

Jonathan Sanchez (07:45):

The program is to identify those who suffer from primary or secondary substance use disorder.

Carol Pehotsky (07:50):

Okay.

Jonathan Sanchez (07:51):

And if the patient is willing, 'cause it's big piece that the-

Carol Pehotsky (07:52):

Hm.

Jonathan Sanchez (07:54):

... patient has to be ready-

Carol Pehotsky (07:56):

Sure.

Jonathan Sanchez (07:56):

... if they are willing, we have recovery coordinators, and they will place them in an in-patient or out-patient recovery center-

Carol Pehotsky (08:04):

Oh.

Jonathan Sanchez (08:04):

... of their choice.

Carol Pehotsky (08:05):

Right at... Right from that ED?

Jonathan Sanchez (08:07):

From those emergency per-

Carol Pehotsky (08:08):

Wow.

Jonathan Sanchez (08:09):

Yes. And that's a big piece of those recovery coordinators of having that experience and those connections in the community to get those patients placed. One of our goals initially is ease of access.

Carol Pehotsky (08:20):

Sure.

Jonathan Sanchez (08:21):

Being accepted into a recovery center, there's a lot of red tape, and-

Carol Pehotsky (08:25):

Oh, sure.

Jonathan Sanchez (08:26):

Yes.

Carol Pehotsky (08:27):

Yeah.

Jonathan Sanchez (08:27):

And the recovery coordinators really eliminate that red tape.

Carol Pehotsky (08:30):

Nice.

Jonathan Sanchez (08:30):

They do all the leg work for the patient-

Carol Pehotsky (08:30):

Okay.

Jonathan Sanchez (08:33):

... and get them placed. So ease of access is very big for this. Yes.

Carol Pehotsky (08:38):

Huge, yeah. Yeah. So basically, I can only imagine the courage it takes that patient to get to the ED and say, "I need help." The next thing they need to do is say, "Yes," to that recovery coordinator, and they can open up all those doors for them?

Jonathan Sanchez (08:48):

Yes. Alls they have to do is-

Carol Pehotsky (08:50):

Wow.

Jonathan Sanchez (08:50):

... one, express to us-

Carol Pehotsky (08:52):

Mm-hmm.

Jonathan Sanchez (08:52):

... if they come to the emergency department that they're there for a drug-related issue-

Carol Pehotsky (08:57):

Hm.

Jonathan Sanchez (08:57):

... or alcohol-related issue.

Carol Pehotsky (08:58):

Sure.

Jonathan Sanchez (08:58):

Or if we identify it secondarily, so for exa-

Carol Pehotsky (09:01):

Okay.

Jonathan Sanchez (09:01):

So if a, example, a patient who comes in, they have an infection in their arm-

Carol Pehotsky (09:06):

Okay.

Jonathan Sanchez (09:06):

... and we identify that infection as a source from IV use.

Carol Pehotsky (09:10):

Oh, interesting. Okay. Yeah.

Jonathan Sanchez (09:11):

So th- our emergency nurses will then notify the recovery coordinator, "Hey, I have a patient here who potentially-

Carol Pehotsky (09:19):

Sure. Could use some help, like they're ready.

Jonathan Sanchez (09:21):

... potentially could use some help."

Carol Pehotsky (09:21):

Yeah. Hm.

Jonathan Sanchez (09:22):

So the recovery coordinators present themselves-

Carol Pehotsky (09:25):

Okay.

Jonathan Sanchez (09:25):

... and they state exactly who they are and why they're there.

Carol Pehotsky (09:26):

Okay.

Jonathan Sanchez (09:29):

And that's the critical piece right there at that point-

Carol Pehotsky (09:31):

Yeah, sure.

Jonathan Sanchez (09:32):

... that hopefully that the patients do accept them, and then they start the conversation.

Carol Pehotsky (09:37):

Wow. And you've been at this from the beginning. Tell us a bit more about how the idea was born and how you were able to help coordinate some resources to make this launch.

Jonathan Sanchez (09:45):

Summit County-

Carol Pehotsky (09:46):

Mm-hmm.

Jonathan Sanchez (09:46):

... really suffered a long time-

Carol Pehotsky (09:48):

Hm.

Jonathan Sanchez (09:48):

... with the overdoses, uh-

Carol Pehotsky (09:49):

Sure.

Jonathan Sanchez (09:50):

... that happened over several years. And Dr. Harte actually approached me-

Carol Pehotsky (09:50):

Mm-hmm.

Jonathan Sanchez (09:54):

... to see if I, the idea of developing a program to help combat overdoses and opiate use within Summit County.

Carol Pehotsky (10:01):

Wow.

Jonathan Sanchez (10:02):

And because this hit on a personal/professional level-

Carol Pehotsky (10:05):

Mm-hmm.

Jonathan Sanchez (10:06):

... it was immediate, "Yes."

Carol Pehotsky (10:07):

Fantastic.

Jonathan Sanchez (10:08):

You know, and so the idea was there. And to be honest, we didn't really know what we had at first.

Carol Pehotsky (10:14):

Okay.

Jonathan Sanchez (10:14):

So I started to evaluate the community. What was best for the community at that time and moving forward, but also how would this program fit for Akron General?

Carol Pehotsky (10:22):

Mm-hmm.

Jonathan Sanchez (10:22):

M- did a lot of research of hospital-based programs throughout the country.

Carol Pehotsky (10:27):

Okay.

Jonathan Sanchez (10:27):

Contacted many organizations to see-

Carol Pehotsky (10:30):

Very good (laughs).

Jonathan Sanchez (10:31):

... what are your successes, but also-

Carol Pehotsky (10:31):

Sure.

Jonathan Sanchez (10:32):

... what are your failures.

Carol Pehotsky (10:33):

Mm-hmm.

Jonathan Sanchez (10:34):

And taking all that information, Recovery's In Reach came about.

Carol Pehotsky (10:38):

That's amazing. You know, for those listeners who've been listening to these episodes in order, you'll note that a few episodes ago, we talked about innovation (laughs), and how it's so important to reach out to other people who are subject matter experts, and Jonathan has done a lovely job of explaining that in action (laughs). I love it when things tie together.

(10:55):

So what are some of the lessons learned that either those programs shared with you that helped you tweak your program, or maybe lessons l- learned from this program that you'd offer to somebody else who was interested?

Jonathan Sanchez (11:07):

One is it has to be the patient's choice.

Carol Pehotsky (11:11):

Hm.

Jonathan Sanchez (11:11):

Many programs throughout the country had really made it their objective to place patients where they thought the patient should go.

Carol Pehotsky (11:12):

Oh, ugh. Yeah.

Jonathan Sanchez (11:21):

And what we've learned over the past couple years with this program is many patients have already attempted recovery several, several times.

Carol Pehotsky (11:28):

Sure.

Jonathan Sanchez (11:29):

And they already have their own opinions-

Carol Pehotsky (11:31):

Mm-hmm.

Jonathan Sanchez (11:31):

... on certain recovery centers.

Carol Pehotsky (11:36):

Oh.

Jonathan Sanchez (11:37):

So-

Carol Pehotsky (11:37):

Oh, not just the process but the place, as well. Sure.

Jonathan Sanchez (11:37):

Not the p-... Correct.

Carol Pehotsky (11:37):

(laughs)

Jonathan Sanchez (11:37):

And so we-

Carol Pehotsky (11:37):

Yeah.

Jonathan Sanchez (11:37):

... we wanted to make it the patient's choice.

Carol Pehotsky (11:38):

Mm-hmm.

Jonathan Sanchez (11:40):

And that has been a success of our program is putting the patient at the forefront, making it their choice, and us as their supporting cast their entire way.

Carol Pehotsky (11:52):

Hm. I love that phrase, supporting cast. That's right. So there's a lot in the literature out there about peer counselors and other folks that help a person with substance use disorder get the help they need and how often. It's so important that those individuals have been down that road themselves. How does that tie into the program we have here, and what have you seen in action?

Jonathan Sanchez (12:13):

We refer to them as peer coaches.

Carol Pehotsky (12:15):

Okay.

Jonathan Sanchez (12:15):

But they're also peer counselors. And we connected with them in Summit County. These individuals are licensed by the State of Ohio as a counselor-

Carol Pehotsky (12:23):

Okay.

Jonathan Sanchez (12:23):

... but they are all recovered themselves.

Carol Pehotsky (12:26):

They are, okay. Yeah.

Jonathan Sanchez (12:27):

And they bring that unique-

Carol Pehotsky (12:29):

Yeah, sure.

Jonathan Sanchez (12:29):

... experience to the patients.

Carol Pehotsky (12:30):

Mm-hmm.

Jonathan Sanchez (12:31):

They let them know what the whole recovery process is gonna be like, they know-

Carol Pehotsky (12:34):

Oh, sure.

Jonathan Sanchez (12:35):

They let them know what withdrawal is gonna be like.

Carol Pehotsky (12:35):

Hm, mm-hmm.

Jonathan Sanchez (12:38):

But they also stay with them the entire time.

Carol Pehotsky (12:38):

Oh, wow.

Jonathan Sanchez (12:41):

So once they've made that connection in our emergency department-

Carol Pehotsky (12:41):

Mm-hmm.

Jonathan Sanchez (12:44):

... they make that relationship throughout their entire transition of recovery.

Carol Pehotsky (12:49):

Oh, wow.

Jonathan Sanchez (12:49):

And hopefully, that relationship sticks.

Carol Pehotsky (12:52):

Mm-hmm.

Jonathan Sanchez (12:52):

If that relationship stays-

Carol Pehotsky (12:54):

Mm-hmm.

Jonathan Sanchez (12:54):

... then the success rate for recovery is a lot higher.

Carol Pehotsky (12:57):

Wow. So I go back to the courage, it has to take somebody who, even if they didn't come in seeking help like the example you gave about the wound, but sometimes it's hard to get to, "Yes," especially if they've tried that journey, they've had other experiences. I want to go back to nurses, right? W- what about us as nurses can really help that patient get to, "Yes," or create that foundation so that when the recovery coordinator comes in or that that patient's already thinking about getting to, "Yes"?

Jonathan Sanchez (13:25):

I think that goes back to the core of why we're nurses, compassion, empathy-

Carol Pehotsky (13:25):

Sure.

Jonathan Sanchez (13:30):

... and our advocacy towards our patients. We, as nurses, have those three elements in us. And taking those and really seeing what the patient needs in their lives-

Carol Pehotsky (13:41):

Mm-hmm.

Jonathan Sanchez (13:41):

... to move forward, and helping then pull that out of them, because the patient has to accept it and realize that-

Carol Pehotsky (13:42):

Yeah.

Jonathan Sanchez (13:47):

... they need it.

Carol Pehotsky (13:47):

Yeah.

Jonathan Sanchez (13:48):

But using our skills to be really close to these patients-

Carol Pehotsky (13:51):

Mm-hmm.

Jonathan Sanchez (13:52):

... will help them hopefully make that decision. And to go back to your point of earlier was the trust.

Carol Pehotsky (13:52):

Yeah.

Jonathan Sanchez (13:59):

If that patient has been in our emergency department-

Carol Pehotsky (14:01):

Well-

Jonathan Sanchez (14:01):

... multiple times-

Carol Pehotsky (14:02):

Yeah.

Jonathan Sanchez (14:02):

... and they trust that emergency department-

Carol Pehotsky (14:02):

Hm.

Jonathan Sanchez (14:02):

... they trust those nurses-

Carol Pehotsky (14:05):

Sure.

Jonathan Sanchez (14:06):

... it's odd to say, but we want them to keep coming back because we're gonna offer that service every single time.

Carol Pehotsky (14:11):

True. You may not get to, "Yes," the first time-

Jonathan Sanchez (14:12):

Correct.

Carol Pehotsky (14:13):

... but maybe you'll get to it the third or fourth.

Jonathan Sanchez (14:14):

Correct, yes.

Carol Pehotsky (14:15):

Okay. I'll be honest, I have not ever worked in emergency room. I have been a patient (laughs).

Jonathan Sanchez (14:15):

Hm.

Carol Pehotsky (14:20):

But, you know, emergency department nurses have a bit of a stereotype that it's all fast-paced and adrenaline. So did you or do you have to do anything to sort of help those nurses in your department sort of be able to switch from go-go-go to I need to create some ease with this patient to help get them to a place where they can be honest with their substance use?

Jonathan Sanchez (14:41):

We did. Initially at first, it was stigma.

Carol Pehotsky (14:43):

Yeah.

Jonathan Sanchez (14:44):

It was understanding the elements behind stigma with this-

Carol Pehotsky (14:44):

Mm-hmm.

Jonathan Sanchez (14:47):

... topic.

Carol Pehotsky (14:48):

Mm-hmm.

Jonathan Sanchez (14:48):

Having the nurses and providers understand-

Carol Pehotsky (14:51):

Sure.

Jonathan Sanchez (14:51):

... why these patients are coming.

Carol Pehotsky (14:52):

Yeah.

Jonathan Sanchez (14:52):

But recognition, then-

Carol Pehotsky (14:54):

Mm-hmm.

Jonathan Sanchez (14:54):

... is we screen every patient that comes in through our doors-

Carol Pehotsky (14:58):

Oh, sure. Yeah. So there isn't that-

Jonathan Sanchez (15:00):

[inaudible 00:15:00].

Carol Pehotsky (15:00):

... judgment at the beginning.

Jonathan Sanchez (15:01):

Yeah, so-

Carol Pehotsky (15:01):

It's everyone.

Jonathan Sanchez (15:01):

But the purpose of the screening-

Carol Pehotsky (15:03):

Mm-hmm.

Jonathan Sanchez (15:03):

... you know, why we're asking these questions so that once a patient does... If they're honest with themselves and they're able to provide that information-

Carol Pehotsky (15:11):

Yeah.

Jonathan Sanchez (15:12):

... to us, that's a big step for that patient.

Carol Pehotsky (15:14):

Yeah.

Jonathan Sanchez (15:15):

And at that point, then we bring our recovery coordinators who are registered nurses themselves.

Carol Pehotsky (15:15):

Oh, great.

Jonathan Sanchez (15:15):

Yes.

Carol Pehotsky (15:15):

I was gonna ask that. Very good. Yeah.

Jonathan Sanchez (15:18):

Yes, yeah. So they, uh, they're registered nurses themselves.

Carol Pehotsky (15:19):

Okay.

Jonathan Sanchez (15:22):

So then they come in, and then they help assist that patient.

Carol Pehotsky (15:27):

And what additional training or development do those nurses who are recovery coordinators have?

Jonathan Sanchez (15:33):

So they are all experienced in nursing addiction-

Carol Pehotsky (15:33):

Oh, great.

Jonathan Sanchez (15:37):

... or mental health, or behavioral health-

Carol Pehotsky (15:37):

Okay.

Jonathan Sanchez (15:39):

... nursing, as well.

Carol Pehotsky (15:39):

M-

Jonathan Sanchez (15:40):

And I recruited them very specifically because-

Carol Pehotsky (15:40):

(laughs) I bet.

Jonathan Sanchez (15:43):

Yeah, 'cause, uh, I love emergency nurses-

Carol Pehotsky (15:43):

Mm-hmm.

Jonathan Sanchez (15:46):

... but we're generalists. I guess what's, like, a term, a master of everything but a master of none.

Carol Pehotsky (15:46):

(laughs) That's right.

Jonathan Sanchez (15:52):

But th- I knew for this patient population, we need people specifically to help care for these patients-

Carol Pehotsky (15:56):

Sure.

Jonathan Sanchez (15:57):

And to help assist them. And so we wanted to find registered nurses-

Carol Pehotsky (15:57):

Yeah.

Jonathan Sanchez (16:01):

... that were specialized in behavioral health but also addiction.

Carol Pehotsky (16:05):

So let's get into some numbers. So since the program's inception, we'll start with roughly how often does that patient get to, "Yes," when that recovery coordinator comes in the door?

Jonathan Sanchez (16:15):

It could be a couple visits.

Carol Pehotsky (16:16):

Yeah, yeah.

Jonathan Sanchez (16:16):

Sometimes we're lucky and we can get somebody off the very first visit, but we've had patients who have been back to us 20 plus times.

Carol Pehotsky (16:24):

Really?

Jonathan Sanchez (16:25):

And we'll s- keep seeing them at 20-

Carol Pehotsky (16:26):

You'll keep trying. That's right. (laughs)

Jonathan Sanchez (16:27):

... 20 more, but usually it takes a couple times.

Carol Pehotsky (16:30):

Okay.

Jonathan Sanchez (16:30):

Mm-hmm.

Carol Pehotsky (16:30):

What kind of success rate or what kind of outcomes have you seen so far?

Jonathan Sanchez (16:34):

So throughout the summer, we've been able to identify close to 1700 patients.

Carol Pehotsky (16:38):

Oh, my gosh. Wow.

Jonathan Sanchez (16:40):

Uh, yeah. And close to 700 of them, we've been able to place in an out-patient or in-patient recovery center.

Carol Pehotsky (16:45):

Oh, my gosh. That's fantastic.

Jonathan Sanchez (16:46):

Yeah.

Carol Pehotsky (16:46):

And do you followup with them at all to see, you know, who they're doing through that program?

Jonathan Sanchez (16:51):

We do. We follow them 30 days, 60 days, 90 days-

Carol Pehotsky (16:54):

Okay.

Jonathan Sanchez (16:54):

... and up to a year. And those are very just general phone calls-

Carol Pehotsky (16:57):

Mm-hmm.

Jonathan Sanchez (16:57):

... to see if they are still within the process. Unfortunately, many don't respond.

Carol Pehotsky (17:03):

Sure.

Jonathan Sanchez (17:03):

But many do.

Carol Pehotsky (17:04):

Yeah.

Jonathan Sanchez (17:05):

And those are the ones that we're able to still keep in contact with and to support them.

Carol Pehotsky (17:09):

That's amazing. And hopefully, they're telling their friends or anybody else who's in a similar situation.

Jonathan Sanchez (17:13):

Yeah.

Carol Pehotsky (17:13):

So that's the numbers part of it. I'm sure it just feels amazing to know that you're making a difference. Do you have any stories you can share about being able to see the difference in front of your eyes?

Jonathan Sanchez (17:23):

Yeah. So a little over a year ago-

Carol Pehotsky (17:26):

Mm-hmm.

Jonathan Sanchez (17:26):

... I was at a local department store.

Carol Pehotsky (17:26):

Mm-hmm.

Jonathan Sanchez (17:28):

And outside of this store, there was a presentation being done by a local recovery center.

Carol Pehotsky (17:33):

Oh, okay.

Jonathan Sanchez (17:33):

Um, giving out pamphlets-

Carol Pehotsky (17:35):

Mm-hmm.

Jonathan Sanchez (17:35):

... and asking people. And I s- k- was coming out of the store, and I stopped, and I listened to what they had to say.

Carol Pehotsky (17:35):

Nice, yeah.

Jonathan Sanchez (17:41):

A gentleman standing next to me said, "This is too far from where I live."

Carol Pehotsky (17:45):

Hm.

Jonathan Sanchez (17:45):

So I just mentioned Recovery's In Reach and where it was located.

Carol Pehotsky (17:49):

Okay.

Jonathan Sanchez (17:49):

And gave him some information. We parted ways.

Carol Pehotsky (17:52):

Okay.

Jonathan Sanchez (17:53):

Fast-forward a year later-

Carol Pehotsky (17:55):

Mm-hmm.

Jonathan Sanchez (17:55):

... gentleman comes to the emergency department and asked to see the manager of Recovery's In Reach.

Carol Pehotsky (18:01):

Okay.

Jonathan Sanchez (18:02):

I go out there-

Carol Pehotsky (18:02):

Mm-hmm.

Jonathan Sanchez (18:03):

... and, uh, you initially, as a, as a nurse manger for an emergency department-

Carol Pehotsky (18:06):

What'd I do wrong now? (laughs)

Jonathan Sanchez (18:06):

Yeah, you think, you think it's a, a negative-

Carol Pehotsky (18:06):

Here we go (laughs).

Jonathan Sanchez (18:09):

... complaint. But I walked in, and he asked who I was.

Carol Pehotsky (18:10):

Mm-hmm.

Jonathan Sanchez (18:13):

And I told him exactly who I was. And he started to tear up-

Carol Pehotsky (18:18):

Hm.

Jonathan Sanchez (18:18):

... and he s- extended his hand to shake my hand. And he proceeded to tell me that not knowing that interaction prior, he didn't know it was the same person.

Carol Pehotsky (18:28):

Oh.

Jonathan Sanchez (18:28):

But it was the information. And at that point in his life, he was, uh, the lowest he could have been. He actually came in as a full arrest to the emergency department. Wonderful nurses and docs were able to save him.

Carol Pehotsky (18:42):

Oh, my gosh.

Jonathan Sanchez (18:43):

But it was that moment he was able to turn his life around-

Carol Pehotsky (18:47):

Hm.

Jonathan Sanchez (18:47):

... um, but thanked me for the services. But he explained how, "Now, I have a full-time job.

Carol Pehotsky (18:54):

Oh, my gosh.

Jonathan Sanchez (18:54):

I was able to see the birth of my g- first grandchild," and his connection with his family is a lot better than what it was prior.

Carol Pehotsky (19:01):

All in a year's time.

Jonathan Sanchez (19:02):

All in a year's time. So that's why we do it.

Carol Pehotsky (19:04):

That's why we do it. Well, I don't think I can ask any questions t- that will have answers to top that, except I will ask, uh, one more, and then we'll get into a little bit of fun stuff. So I'm confident that you've inspired a lot of people who've listened to this episode. And we're very fortunate that in Summit County and in our organization, we va- have access to some resources. So somebody who you've inspired who doesn't even know the first place to start, maybe they're in leadership, maybe they're not, what advice would you give them to just start the ball rolling, at least, to be able to offer similar types of connections in their community?

Jonathan Sanchez (19:35):

If you have a passion for something-

Carol Pehotsky (19:38):

Mm-hmm.

Jonathan Sanchez (19:38):

... ask the questions.

Carol Pehotsky (19:40):

Okay.

Jonathan Sanchez (19:40):

Who do I get in contact with?

Carol Pehotsky (19:41):

Mm-hmm.

Jonathan Sanchez (19:42):

What is currently being done? What is currently not being done? You will find those answers whether it's within a hospital system-

Carol Pehotsky (19:49):

Mm-hmm.

Jonathan Sanchez (19:49):

... or your community officials. You'll be able to find the answers. And there are plenty of community-based programs that are out there-

Carol Pehotsky (19:49):

Hm, mm-hmm.

Jonathan Sanchez (19:59):

... that want individuals to be part of their program-

Carol Pehotsky (20:02):

Sure, yeah.

Jonathan Sanchez (20:02):

... to help support, but also to become innovative-

Carol Pehotsky (20:05):

Mm-hmm.

Jonathan Sanchez (20:05):

... because what you and I may be thinking may be something completely different than somebody else.

Carol Pehotsky (20:11):

Sure.

Jonathan Sanchez (20:11):

And that third person's idea-

Carol Pehotsky (20:13):

Brings it all together. Yeah.

Jonathan Sanchez (20:15):

It very much well could be, yeah. So just ask questions and reach out, because if you keep it to yourself-

Carol Pehotsky (20:20):

That's where it's gonna stay.

Jonathan Sanchez (20:21):

That's where it's gonna stay.

Carol Pehotsky (20:22):

Yup. Well, and, and it's a great point that there are resources out there.

Jonathan Sanchez (20:22):

Mm-hmm.

Carol Pehotsky (20:25):

So it's not that as a nurse I have to figure out how to build a-

Jonathan Sanchez (20:26):

Yeah.

Carol Pehotsky (20:28):

... recovery program. It's how do I get the right people talking to each other to make things happen?

Jonathan Sanchez (20:32):

Correct.

Carol Pehotsky (20:33):

Well, our community and our organization is so much better off because of the efforts of you and your team, Jonathan.

Jonathan Sanchez (20:34):

Well, thank you.

Carol Pehotsky (20:38):

Thank you very much. So now we're gonna flip to the speed round, which is where we let our audience get to know a little bit more about you as an amazing human being and in addition to being such an amazing subject matter expert. So we'll start with what's something you do for you to recharge?

Jonathan Sanchez (20:52):

I like to get my stress out through a hard workout-

Carol Pehotsky (20:55):

All right.

Jonathan Sanchez (20:56):

... and sweat it out-

Carol Pehotsky (20:56):

Okay. (laughs)

Jonathan Sanchez (20:57):

... 'cause I feel 10 times better when... I can be completely stressed at work, I go and workout, and I feel 10 times better.

Carol Pehotsky (21:04):

Are you punching a punching bag, are you lifting weights? What's your go-to?

Jonathan Sanchez (21:07):

Lifting weights and hard cardio, nothing specific. I have-

Carol Pehotsky (21:12):

(laughs) Just got to get it out whatever it is.

Jonathan Sanchez (21:13):

I just got to get it out however I can get it out. It's-

Carol Pehotsky (21:14):

All right. Awesome. And what's something about you that surprises people?

Jonathan Sanchez (21:18):

I have an identical twin brother.

Carol Pehotsky (21:20):

Oh, really?

Jonathan Sanchez (21:21):

Yeah.

Carol Pehotsky (21:21):

Local to the area?

Jonathan Sanchez (21:22):

No. He is in the Air Force.

Carol Pehotsky (21:24):

Hm.

Jonathan Sanchez (21:24):

He's a Senior Master Sergeant down in Texas.

Carol Pehotsky (21:27):

So he's not snooping around as the evil Jonathan or anything like that.

Jonathan Sanchez (21:27):

No, he's not.

Carol Pehotsky (21:27):

(laughs)

Jonathan Sanchez (21:31):

No. He's the random man that looks like me. Might be him.

Carol Pehotsky (21:32):

(laughs) There you go. Well, thank you so much for joining us today.

Jonathan Sanchez (21:36):

All right. Thank you.

Carol Pehotsky (21:41):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(22:15):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.