Alcohol liaison services (ALS) Louise Poley Consultant Nurse in - - PowerPoint PPT Presentation

“Measuring the Units” Alcohol liaison services (ALS)

Louise Poley Consultant Nurse in Substance Misuse Cardiff and Vale University Health Board

The report highlights

• A younger than average cohort
• A lack of specialist interest and input
• The opportunities to make a difference that

were missed- both to individuals and health service costs

• Engagement with ALS can improve patient
• utcomes yet only 3% of hospitals reported

having a comprehensive service

The Aims of an ALS

• To improve the patient experience and outcomes
• Reduce the length of stay in hospital when

appropriate - early identification and prompt intervention

• Reduce readmission rates by utilising a stepped

care approach - Brief interventions for hazardous drinking and engagement with specialist services for dependent drinking

• Co-ordinate care and treatment during admission

The Aims of an ALS

• A multi-disciplinary approach to engaging patients

with appropriate community services and support networks

• To change negative perceptions, improve cultures

and raise the profile of the management of alcohol

• To develop effective protocols and pathways of

care that support sound and ethical clinical practice

The Roles of an ALS

• Prevention
• Clinical management
• Engagement with treatment
• Training and education
• Development of clinical guidelines, care

pathways and hospital strategies

Prevention - Screening

• Routine, early identification of hazardous, harmful and

dependent drinking - excessive drinking not always evident

• Comprehensive history taking for heavy/dependent

drinking

• Opportunistic health promotion intervention in itself
• May be predictive of severity of withdrawals and inform

clinical management

• Fast Alcohol Screening Test/AUDIT

Prevention - ABIs

• Widespread delivery of alcohol brief interventions
• Personalised feedback, health advice, harm reduction

techniques, written information

• Teachable moment - Right place, right time
• Cost effective
• Can be conducted by almost anyone in most settings

Perceived Barriers

• Lack of knowledge, skills, time
• Competing priorities
• Cynicism regarding effectiveness

Clinical management

• Responsive and comprehensive assessment including co-

morbidities - mental health problems/poly-drug use

• Management of alcohol withdrawals
• Implementation of CIWA-Ar
• Prevention and management of complications including

Wernicke’s and Delirium Tremens

• Focus on repeat attendees – increased bed days may

prevent future bed days/admissions

• Onward referral and engagement with appropriate

treatment

Engagement

• Assessment of need and complexities
• Motivational work
• Liaison, onward referral to appropriate community services

Addiction Units GPs Housing organisations Counselling Services Mental health services Relapse Prevention Programmes LA for Assessment for Rehabilitation

Training and Education

• Widespread comprehensive training programmes for nursing

and rotational doctors Screening and brief interventions Comprehensive history taking and assessment Clinical management of alcohol withdrawals Prevention and management of associated complexities Availability of and appropriate referral to community resources

• E-learning packages
• University modules for under/post graduates

Clinical Guidelines

• Comprehensive hospital alcohol strategy that includes

Routine screening and Brief interventions Clinical guidelines and pathways Management of alcohol withdrawals and complications Referral criteria Discharge planning

Cardiff Experience

• One liaison nurse for:-

2 teaching hospitals 11 miles apart total of 1,500 beds dealing with both drug and alcohol related admissions 9-5 weekdays

• Poor staffing levels – challenging to release staff for training
• Amongst the busiest EU in the UK, high levels alcohol

consumption in South Wales

• Community waiting lists

However….

• FAST screening implemented in Unscheduled Care and

short stay medical wards

• Brief Intervention training programme on-going and

evidence of use

• CIWA-Ar implemented with training
• 650 + patients assessed, treated, referred on annually
• Wide network of multi-disciplinary professional support

However….

• Clinical guidelines implemented for

Pharmacotherapy of detoxification Administration of parenteral thiamine Management of illicit opiate users

• WKS care pathway implemented (Homeless-EU)
• Increase in appropriate community referrals
• Audit on-going