This is a new column that really developed from a presentation at the 2013 INTNSA (International Nurses Society on Addictions) conference. It was suggested by one of the keynote presenters that we should create such a column as a way to learn from each other. We all have practice "pearls" no matter what our practice is.

My belief is that we all try to base our practice on current evidence; however, in reality, most of the time, there is no or limited evidence. Sometimes, as one presenter termed it so well, we only have to get into the "weeds" of what is going on. I view it this way, instead of viewing something from the outside looking in-we have to get down to the nitty gritty, see what is going on, and then not only learn from this experience but also take it to the next level by trying to improve what we have seen.

This column then focuses on the "nitty gritty" of what one sees and has learned from their practice in addictions nursing. It is sharing the pearls that we have gathered so that others can implement these "pearls" to improve their practice as well. By doing this, many more individuals will benefit rather than just the individuals in each of our practices.

This column then really is dissemination of information that goes on in everyday life. I anticipate that there will be columns that are serious, and some others may be humorous. It will be really dependent on what the authors are willing to share.

Before submitting your "story" to the Journal, please go to the Web site, http://www.editorialmanager.com/jan, and register if you are a new submitter. After registering, download the Instructions for Authors and carefully review so you will know what is expected for submitted manuscripts. After you understand the Journal policies and you have altered your manuscript if necessary to comply, you are ready to submit your manuscript to the Journal Web site. Choose the category "Stories from the Field" from the drop-down menu to submit your manuscript. Al Rundio, the column Editor, will review and get back to you.

To start this column, I will share something that we did in my practice to try to improve care and safeguard patients and staff.

THE SEARCH PROCEDURE

Our quality program where I practice mandates that we implement a FEMA (failure, effect, mode and analysis). In other words, it is taking a proactive stance to quality improvement. It looks at something that has not occurred in the facility; however, the potential is there. So let's analyze the situation, and look at what could cause the event, what effect could result, and how then do we prevent it from happening.

One of the counselors at our facility noticed that a crack pipe was found on one of the outdoor patios. This triggered discussion and the fact that either individuals were bringing in paraphernalia or having such items delivered to use drugs. We discussed the situation and our concerns with the treatment team and decided that it was time to implement more stringent search guidelines on admission. We do medically monitored detoxification. What if a patient was on a prescribed detox protocol receiving controlled substances and also had some drug delivered. We could find a patient not breathing. The potential of problems was endless. Because of this situation, we developed more stringent search guidelines. The process starts on admission where the client is questioned if they have brought anything into the facility and if they would relinquish such. They then sign a form following explanation by the admissions staff that attests to them not having anything on their person and that they would not have anything brought into the facility as such action could be a negative consequence to the community. They also sign stating that they have been advised, should any such behavior occur, that they would be administratively discharged as well as the police being notified to arrest them. After the admission process, before going to the nursing unit, a search is conducted in the examination room by two staff members. The patient gets undressed and puts on a disposable paper gown. Every article of clothing and every item are searched by the staff. The patient is also requested to go into a squatting position and instructed to cough hard. As a nurse practitioner and a credentialed member of the medical staff, I am not responsible for conducting the searches with staff; however, when the facility is busy and I am available, I will definitely pitch in and do this. I learn from each one of these. During one search, when the patient squatted and coughed, a cell phone was emitted from his rectum. The staff have found pills hidden under filters in cigarettes and under the stick in ChapStick, just to name a few hiding places. We do not do body cavity searches; however, one can see that what we have done has been effective. Is this system perfect? I would say no, but there is no perfect system. It certainly is an improvement over what has been done in our facility and has prevented potentially serious adverse outcomes. A key component is teaching the staff to take the search as one of the most important tasks that they do and to consider any potential hiding place for drugs. We have also executed administrative discharge and police arrest when patients violated what they agreed too, that is, not having drugs delivered to the facility. We continue to learn from conducting these searches and share with staff hiding places that we learn about by getting down to the nitty gritty of doing an admission search.