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 outcomes 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