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“Measuring the Units” Alcohol liaison services (ALS)

“Measuring the Units” Alcohol liaison services (ALS). Louise P oley 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

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“Measuring the Units” Alcohol liaison services (ALS)

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  1. “Measuring the Units”Alcohol liaison services (ALS) Louise Poley Consultant Nurse in Substance Misuse Cardiff and Vale University Health Board

  2. 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

  3. 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

  4. 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

  5. The Roles of an ALS • Prevention • Clinical management • Engagement with treatment • Training and education • Development of clinical guidelines, care pathways and hospital strategies

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

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