Development of alcohol liaison within the Royal Devon and Exeter hospital

Sally JarmainClinical Lead in Alcohol

Why bother?

12% of A&E attendances are alcohol related (Pirmohamed, 2000)

34-36% of orthopaedic admissions and 33-50% of head injury patients are drinking at hazardous levels (Chick, 1991)

20% of patients admitted for non-alcohol related reasons are drinking at harmful levels (RCP, 2001)

Hospital admissions for the 3 main alcohol-specific conditions (mental health, liver disease and acute intoxication) has doubled in the last 10 years (National Audit Office, 2008)

Royal College of Physicians (2001) Alcohol: Can the NHS afford it? Screening tools to be used to detect problem drinkers;

A recognised management plan and established protocols to be developed;

Pharmacology pathways to be used to ensure safe detoxification;

Concurrent vitamin therapy to be administered to patients with alcohol-related problems;

Alcohol education and training to be given to hospital staff to improve their practice with and attitudes to this patient group;

Appropriate counselling and onward referral to be offered to patients;

Alcohol liaison nurses to be appointed within all acute hospitals to effect the above recommendations and raise the issue of alcohol-related administration and governance.

Aims of Project

Encourage hospital staff to screen patients using a screening questionnaire

Give brief advice where appropriate

Provide advice and information to medical/nursing staff on the management of people with alcohol problems

Reduce hospital bed days by facilitating community detoxification where appropriate

Development of post within RD&E so far...

Communication about role

Screening tools

Care pathways

Guidelines

Screening tools

Paddington alcohol test

Audit

Fast

Others e.g. MAST, Cage

ICP following referral to Liaison NurseReferral received by alcohol liaison nurse. Patient will be triage assessed on the ward,

within 1 working day of the referral being received. Assessments will normally take place during the morning.

Does client want to be seen by alcohol

service?

Yes No

Is the client dependant on alcohol?

Provide “Sensible drinking” and “Addaction” leaflets. Give brief advice on reducing alcohol consumption

Yes No

Is the client currently prescribed medication for alcohol

detoxification (including medication for delirium tremens or alcohol-related hallucinosis)?

Client will be referred for ENDAS keyworker by alcohol liaison nurse.

Does the client have complex needs? (learning disability, repeated presentations at A and E for

suicidal ideation, a mental health care manager or child protection issue)

No

Is the client drinking at a harmful or hazardous level?

YesNo

Alcohol liaison nurse will refer to Addaction and

provide “sensible drinking” and “Addaction” leaflets.

Provide “Sensible drinking” leaflet. Give brief advice on

reducing alcohol consumption

Yes

Yes

No

Alcohol liaison nurse will offer monitoring and support for client

whilst they remain in hospital and will assess suitability for community

detoxification if appropriate.

Following detoxification or discharge from hospital (whichever happens first), client will be referred by liaison nurse to ENDAS

keyworker for relapse prevention work. Liasion nurse will continue to offer support to client until a keyworker is allocated.

Outcomes

Briefadvice/screening

Full assessment

Currently in tier 3treatment

Did not engage intreatment

Successfullycompleted treatment

38 39

16

14

9

Learning and future development

Audit

Changes to referral system/care pathways

Development of guidelines

Training

Increasing wards covered by nurse

A&E

Contact details

Sally Jarmain (Clinical lead in alcohol)EndasWonford House HospitalDryden RoadExeterEX2 5AF

Tel: 01392 208210Sally.jarmain@nhs.net