Training Patient Feedback Introduction Challenges ED Staff Team of Alcohol Awards Future I.B.A Team Plans Community Alcohol Detoxification I.B.A and Care Link Nurses Pathway Case Studies Developments Facilitator The UHSM Alcohol Team The UHSM Alcohol Team – 2 Years On 2 Years On –
Introduction of Alcohol I.B.A Team • Team introduced to UHSM in July 2009 Identification and Brief Advice Care Facilitator - AUDIT-C introduced into the - Referral criteria/procedure developed department - Any patient drinking at dependent levels - Extended Brief Intervention Clinics assessed and referred on where appropriate set up - Relationships with medical teams/nursing - Doctors/nurses in the department staff developed trained to deliver brief interventions - Community Detoxification Protocol - Links developed between hospital introduced in February 2010 and community teams
Introduction of Alcohol I.B.A Team I.B.A and Care Facilitator Roles Alcohol Specialist Nurse Care Facilitator Numbers screened in the ED April ‘10- Sept ‘11: Numbers of patients seen April ‘10- Sept ‘11: 19,006 1,009 Brief Advice delivered in the ED: Referrals to community services 6,197 341 Extended Brief Intervention delivered in Patients suitable for discharge on the Rapid Access Clinics Community Detoxification Protocol 368 99 Referrals to community services 282
Training Introduction of Alcohol ED Staff I.B.A Team I.B.A and Care Facilitator Roles • 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 Difficulties with training Positive outcomes from training - Time constraints mean there is often only 20 - Referrals into alcohol services, this never used minutes in which to deliver training to new Doctors to happen! - Staffing in the Emergency Department - Clinical staff in the Emergency Department take means that nurses find it difficult to attend training more of an interest in the work we are doing sessions - Some clinical staff do not see the training as a - Staff have a better understanding of Alcohol Use priority and do not attend Disorder - Rotation of Junior staff leads to reductions - Working with staff to reduce unnecessary in screening admissions
Training Introduction ED Staff of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Pathway Facilitator Roles • Community Alcohol Detoxification Protocol Introduced February 2010 - 99 patients assessed as suitable (April Patient must : 10 – Sept 11) - have completed 72 hours of their Chlordiazepoxide regime as an in-patient - 82% remained alcohol free at follow - express a wish to remain alcohol free up appointment (9 patients unknown, on discharge 21 patients awaiting inputting) - have no history of delirium tremens - have no acute medical/ mental health - 396 bed nights saved (although problems this would benefit from more - be willing to engage in post-detox support in-depth analysis) - be assessed as having an adequate social situation to return to - Well received by staff
Training Patient Feedback Introduction ED Staff of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Pathway Facilitator Roles • 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”
Training Patient Feedback Introduction ED Staff of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Pathway Link Nurses Facilitator Roles • Link Nurses - First training rolled out April 2011 - 8 nurses trained to date - Training offered to nursing staff on all -10 awaiting training medical and surgical wards -17 wards with no link nurse identified ( this is further discussed in ‘challenges’) - Staff given alcohol information training and information packs Training to come: Updated NICE guidelines Pabrinex Wernicke-Korsakoff’s Syndrome
Nursing Times Award 2010 • Team Awards University Hospital South Manchester Staff Award 2011
Training Patient Feedback Introduction Team ED Staff Awards of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Pathway Link Nurses Case Studies Facilitator Roles • 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
Training Patient Feedback Introduction Team ED Staff Awards of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Pathway Link Nurses Case Studies Facilitator Roles • 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
Training Patient Feedback Introduction Team Challenges ED Staff Awards of Alcohol I.B.A Team Community Alcohol Detoxification I.B.A and Care Link Nurses Case Studies Pathway Facilitator Roles • 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 often 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
Training Patient Feedback Challenges Introduction Team ED Staff Awards of Alcohol I.B.A Team Community Alcohol Detoxification Link Nurses Pathway I.B.A and Care Case Studies Developments Facilitator Roles • Developments Care Facilitator Identification and Brief Advice - The introduction of the new Kardex/ - The Audit-C tool has now been integrated Withdrawal Pathway has led to increased into the Cascard confidence in staff members to assess - A new Kardex has been developed with the severity of withdrawal and manage CIWA-Ar to identify and scale treatment for accordingly withdrawal symptoms - Management plans have been developed to - An ‘Alcohol Withdrawal Pathway’ has been support staff in their assessment of the Top introduced to the Emergency Department 20 most frequent attenders to support the new Kardex
Training Patient Feedback Introduction Team ED Staff Challenges Awards of Alcohol Future I.B.A Team Plans Community Alcohol Detoxification I.B.A and Care Pathway Link Nurses Case Studies Developments Facilitator Roles • 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
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