(#11) Integrating Trauma-Informed Care into an Inpatient Medical Setting: A Case Report

Abstract: Key principles of a trauma-informed care (TIC) approach include promoting a sense of physical and psychological safety, emphasizing collaboration, building trust, and empowering patients to make choice. However, most applications of TIC in research focus on the outpatient setting, residential treatment setting, or acute psychiatric inpatient setting. This case report follows a 61-year-old male with current severe opioid use disorder (OUD) and post-traumatic stress disorder (PTSD) admitted for recurrent infections. Although received IV medications for bacteremia and fungemia, he continued to have recurrent infections, with subsequent reports by staff causing suspicion for self-injection of hydromorphone crushed into apple sauce into his PICC line. Given that the patient's severe OUD was actively and directly conflicting with the goals of the primary team, the Psychiatry team was consulted. Although limited in their role as a consult-liaison service, the psychiatry team was able to initiate therapeutic rapport with the patient by integrating a TIC approach. This in turn allowed the patient to open-up regarding his substance use, history of IV drug use, and discuss medication options in a productive manner with the team.

Short Description: Key principles of a trauma-informed care (TIC) approach include promoting a sense of physical and psychological safety, emphasizing collaboration, building trust, and empowering patients to make choice. This case report endeavors to depict how TIC can be integrated into an inpatient medical setting, the barriers that may arise, and ways to navigate such challenges in order to build therapeutic rapport with a patient with a history of PTSD and severe substance use.

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