“Measuring the Units”Alcohol liaison services

(ALS)

Louise PoleyConsultant Nurse in Substance Misuse

Cardiff and Vale University Health Board

The report highlightsA 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 ALSTo 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 ALSA 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 ALSPrevention

Clinical management

Engagement with treatment

Training and education

Development of clinical guidelines, care pathways and hospital strategies

Prevention - ScreeningRoutine, 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 - ABIsWidespread delivery of alcohol brief interventions Personalised feedback, health advice, harm reduction techniques, written informationTeachable moment - Right place, right timeCost effectiveCan be conducted by almost anyone in most settings

Perceived BarriersLack of knowledge, skills, timeCompeting prioritiesCynicism regarding effectiveness

Clinical managementResponsive 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

EngagementAssessment of need and complexities

Motivational work

Liaison, onward referral to appropriate community services

Addiction UnitsGPsHousing organisationsCounselling ServicesMental health servicesRelapse Prevention ProgrammesLA for Assessment for Rehabilitation

Training and EducationWidespread comprehensive training programmes for nursing

and rotational doctors

Screening and brief interventionsComprehensive history taking and assessmentClinical management of alcohol withdrawalsPrevention and management of associated complexitiesAvailability of and appropriate referral to community

resources

E-learning packagesUniversity modules for under/post graduates

Clinical GuidelinesComprehensive 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 ExperienceOne liaison nurse for:-

2 teaching hospitals11 miles aparttotal of 1,500 bedsdealing with both drug and alcohol related admissions9-5 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 detoxificationAdministration of parenteral thiamineManagement of illicit opiate users

WKS care pathway implemented (Homeless-EU)

Increase in appropriate community referrals

Audit on-going