The UHSM Alcohol Team The UHSM Alcohol Team 2 Years On 2 Years On - - PowerPoint PPT Presentation

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Developments Case Studies Challenges

Future Plans

The UHSM Alcohol Team The UHSM Alcohol Team – – 2 Years On 2 Years On

• Team introduced to UHSM in July 2009

Introduction

• f Alcohol

I.B.A Team

Identification and Brief Advice

• AUDIT-C introduced into the

department

• Extended Brief Intervention Clinics

set up

• Doctors/nurses in the department

trained to deliver brief interventions

• Links developed between hospital

and community teams

Care Facilitator

• Referral criteria/procedure developed
• Any patient drinking at dependent levels

assessed and referred on where appropriate

• Relationships with medical teams/nursing

staff developed

• Community Detoxification Protocol

introduced in February 2010

Alcohol Specialist Nurse

Numbers screened in the ED April ‘10- Sept ‘11:

19,006

Brief Advice delivered in the ED:

6,197

Extended Brief Intervention delivered in Rapid Access Clinics

368

Referrals to community services

282

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles

Care Facilitator

Numbers of patients seen April ‘10- Sept ‘11:

1,009

Referrals to community services

341

Patients suitable for discharge on the Community Detoxification Protocol

99

• Training Emergency Department Staff

Nurses and Doctors in the Emergency Department are trained in Identification and Brief Advice on a rolling programme, with approximately 18 members of staff trained every quarter

I.B.A and Care Facilitator Roles Training ED Staff

Introduction

• f Alcohol

I.B.A Team

Positive outcomes from training

• Referrals into alcohol services, this never used

to happen!

• Clinical staff in the Emergency Department take

more of an interest in the work we are doing

• Staff have a better understanding of Alcohol Use

Disorder

• Working with staff to reduce unnecessary

admissions

Difficulties with training

• Time constraints mean there is often only 20

minutes in which to deliver training to new Doctors

• Staffing in the Emergency Department

means that nurses find it difficult to attend training sessions

• Some clinical staff do not see the training as a

priority and do not attend

• Rotation of Junior staff leads to reductions

in screening

• Community Alcohol Detoxification Protocol

Introduced February 2010 Patient must:

• have completed 72 hours of their

Chlordiazepoxide regime as an in-patient

• express a wish to remain alcohol free
• n discharge
• have no history of delirium tremens
• have no acute medical/ mental health

problems

• be willing to engage in post-detox support
• be assessed as having an adequate

social situation to return to Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway

• 99 patients assessed as suitable (April

10 – Sept 11)

• 82% remained alcohol free at follow

up appointment (9 patients unknown, 21 patients awaiting inputting)

• 396 bed nights saved (although

this would benefit from more in-depth analysis)

• Well received by staff

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Patient Feedback

• Patient Feedback

“Someone that understood what I was going through. A fantastic nurse” “The Alcohol Nurse helped me realise the danger I was putting myself in” “The Nurse was understanding and gave me good advice” “The Alcohol Specialist Nurse listened to me and I didn’t feel judged by the nurse unlike other people I have met”

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback

• Link Nurses
• First training rolled out April 2011
• Training offered to nursing staff on all

medical and surgical wards

• Staff given alcohol information training

and information packs Training to come: Updated NICE guidelines Pabrinex Wernicke-Korsakoff’s Syndrome

• 8 nurses trained to date
• 10 awaiting training
• 17 wards with no link nurse identified (this

is further discussed in ‘challenges’)

Nursing Times Award 2010

• Team Awards

University Hospital South Manchester Staff Award 2011

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Case Studies

• Case Study 1
• Patient A, male, aged 51, admitted to a medical ward with ‘alcohol withdrawal’ as the

presenting problem

• Patient A has explained to staff that his relationship has recently broken down and he

cannot return home as a result. Care Facilitator asked to see patient on day of discharge to look into what support is available for him in the community

• On assessment, the patient is unable to remember where he used to live
• It becomes apparent that the patient is not orientated to place/date/time
• After liaison with the Care Facilitator, the doctors on the ward conduct further tests and the

patient is seen by a psychiatrist

• The patient is diagnosed with Alcohol Related Dementia and is deemed unsafe to return to

independent living

• The patient remains on the ward until a residential placement becomes available

• Case Study 2
• Patient B, Male, aged 30, attended the ED with a facial problem, not alcohol related
• Screened by ED staff, Audit-C = 12, offered an appointment in the Rapid Access Clinic

with the Alcohol Specialist Nurse. Patient declined and was given a Drink Smart Guide

• 3 months later the team received a call from Patient B asking for an appointment, he

has tried to follow Drink Smart Guide on his own, succeeded at first but now struggling

• On assessment drinking up to 10 units Mon-Fri and 12 Sat-Sun = 74 units/week

= HIGHER RISK

• Has a well paid job, lives with partner, no children
• Drinks to relieve stress, and past ‘emotional baggage’ suffers with anxiety
• 5 sessions over a period of 2 months
• Now drinking 3.2 units in the week with 2 days off and 6-10 units on Sat

= LOWER RISK

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Case Studies

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Case Studies Challenges

• Challenges
• Despite regular training, staff still do not always feel comfortable asking alcohol questions

to people presenting in the Emergency Department, especially older people, women, black and minority ethnic groups

• UHSM did not initially have a computer based system for Audit-C so the questions were
• ften not asked
• When the questions are asked, not all staff deliver brief advice
• It has been difficult to get the backing of staff in the Emergency Department as it is difficult

to measure the effect/outcome of the team

• Staffing levels have impacted on the roll out of the Link Nurse package across the hospital
• Staff confidence in discharging patients ‘to drink’ when medically fit
• Managing frequent attenders

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Case Studies

• Developments

Identification and Brief Advice

• The Audit-C tool has now been integrated

into the Cascard

• A new Kardex has been developed with the

CIWA-Ar to identify and scale treatment for withdrawal symptoms

• An ‘Alcohol Withdrawal Pathway’ has been

introduced to the Emergency Department to support the new Kardex

Care Facilitator

• The introduction of the new Kardex/

Withdrawal Pathway has led to increased confidence in staff members to assess severity of withdrawal and manage accordingly

• Management plans have been developed to

support staff in their assessment of the Top 20 most frequent attenders

Developments Challenges

Introduction

• f Alcohol

I.B.A Team

I.B.A and Care Facilitator Roles Training ED Staff Community Alcohol Detoxification Pathway Link Nurses Patient Feedback Team Awards Developments Case Studies Challenges

Future Plans

• Future Plans
• To produce posters for the Emergency Department highlighting the fact that all patient

will be asked about their alcohol consumption

• To continue to improve on screening rates in the ED and referrals to the Alcohol

Specialist Nurse

• To receive referrals from all departments/wards of the hospital
• To ensure every ward has a link nurse and to continue to update their knowledge and

skills

• To continue to develop practitioners understanding of Wernicke-Korsakoff’s Syndrome

and it’s management

• Reaching out into the wider Wythenshawe community regarding reducing alcohol related

harm

• Extending management plans to the Top 100 to ensure all frequent attenders are

properly managed

Any Questions?

Hazel Donovan – Alcohol Specialist Nurse – Hazel.Donovan@UHSM.NHS.UK Jodie Plumley – Care Facilitator – Jodie.Plumley@UHSM.NHS.UK