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ALCOHOL RELATED ATTENDANCES IN CHILDREN. KIM WILLIAMS LEAD NURSE, EMERGENCY DEPARTMENT Alder Hey Children’s NHS Foundation TRUST. BACKGROUND . Total 60,000 new attendances year 0-16 years 150 – 200 patients a day. Background. Childrens NSF National Alcohol Harm Reduction Strategy

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Alcohol related attendances in children l.jpg

ALCOHOL RELATED ATTENDANCES IN CHILDREN

KIM WILLIAMS

LEAD NURSE, EMERGENCY DEPARTMENT

Alder Hey Children’s NHS Foundation TRUST


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BACKGROUND

  • Total 60,000 new attendances year

  • 0-16 years

  • 150 – 200 patients a day


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Background

  • Childrens NSF

  • National Alcohol Harm Reduction Strategy

  • Every Child Matters

  • Local Concerns


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BACKGROUND

  • Increasing number of alcohol related attendances Audit 2004

  • Inconsistent management

  • Poor follow up & support



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WHAT COULD WE DO?

  • Clinical care pathway

  • Standardise medical assessment/treatment

  • Standardise information given to patients

  • Offer Brief intervention clinic follow up

  • Establish links with existing support services



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WHAT COULD WE DO?

  • Links with education

    • School nurses

    • Identify high use schools

    • Healthy schools co-ordinator

  • Links with police

    • Hot spots of activity

    • Alcohol suppliers

  • Links with MRAS



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Brief intervention clinic

  • Nurse Led

  • Training – motivational interviewing

  • Once only – 30 -40 mins

  • Information pack prior to attendance

  • Seen within a week of event


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BIC

  • ‘Its all about you’- social history

  • Reflection – Morning after leaflet

  • Explore knowledge

  • Personal safety

  • Risk taking behaviours

  • Screening tool – young people at risk

  • Referral as appropriate.


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DESIRED OUTCOMES

  • Change in behaviour

  • No re-attendance to AED

  • Early identification of substance misuse

  • Referrals to specialist services in appropriate areas

  • Collaborative working with schools

  • Collaborative working with police

  • Data collection to add to national database


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Pathway Audit

Jan 05 to May 09

743 alcohol related attendances

67% Female

70% aged 14 – 16yrs

18% admitted to hospital.


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AGE RANGE - ALCOHOL

120

100

80

60

No of patients

40

20

0

Under

11

12

13

14

15

16

Over

10

16

Age



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Alcohol audit

  • About half are drinking in streets/parks

  • With friends, few alone

  • Alcohol bought from shops (20%)

  • Co-ingestion in 15%

    • Paracetamol, cannabis, caffeine

    • Ecstacy, amphetamines, cocaine and heroin

  • 17% found by Police/Stranger

  • 40% associated injuries


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Is this the first time?

  • Sometimes - 38%

  • Regular - 16%

  • Never - 14%

  • Not recorded - 32%


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Case 2What lies beneath

  • 14yr old girl

  • Hand laceration – day after

  • Fallen whilst drunk

  • Admitted to drinking Vodka Friday nights

  • Alcohol from off license

  • Drinks with 1 friend mostly


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BIC

  • Drinks half bottle of vodka and cider

  • Has been drinking for 2 yrs

  • Has events that she can’t remember

  • Truants from school

  • Trouble with the police once

  • Father died tragically 3yrs previous

  • No bereavement counselling

  • Visits grave almost every day


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BIC

  • Recognised problem

  • Wanted to give up

  • Referral to specialist services


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Group Therapy

  • 13yr old girl, drinking vodka in park

  • 5 friends + group of boys

  • Vodka obtained by boys

  • 2 ‘drunk’ 2 sober 1 semi conscious

  • Explored event from different perspectives

  • Feelings/concerns/shared experience


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Group Therapy

  • Discussion

  • Risk taking

  • Future strategies

  • Experimentation


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WHAT EFFECT ARE WE HAVING?

  • Early referral to appropriate services

  • Recognition of vulnerability of these young people

  • Opportunity for exploration of underlying issues – depression/anxiety/anger


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What we have learned?

  • Local alcohol and substance misuse services

    • Lots around at Tier 2 and 3

    • Real need at Tier 1 provision

  • Need for “joined up working”

    • Education, Social Care and other Healthcare providers

  • Adolescent issues



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Thank you

If you are young and you drink a great deal it will spoil your health, slow your mind, make you fat

- in other words, turn you into an adult.

P.J. O'Rourke


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