NHS

Responding to Alcohol-related Harm in Acute

Hospitals :

The Alcohol Specialist Nurse

Responding to Patients Needs

Need for a patient centered service.

Need to bridge primary secondary care

boundaries.

Need for effective mechanisms of follow-up post

inpatient treatment.

Need to respond quickly and effectively to

complex needs.

Need to support & augment medical interventions.

Nurses best placed;

but they come in many guises

Develop a competency framework that is congruent with desired outcomes

Completion of training needs analysis based upon review of current knowledge base and clinical experience.

Development and provision of training for nurses. Identification of ongoing support mechanisms for

contemporaneous health care staff.

Understanding partner needs

Agree local guidelines to support referrals to nurse

led clinics.

Agree local guidelines to support referrals from

nurse led clinics.

Practical Issues

Nurse responsibilities

Nurse autonomy

Nurse safety

Patient expectations

Multidisciplinary expectations –role legitimacy

AfC banding

All that done;

how do we know if

nurses are effective?

A prospective controlled cohort A prospective controlled cohort study:study:

Brief Interventions for alcohol Brief Interventions for alcohol dependent patients in an acute dependent patients in an acute hospital settinghospital setting

Authors: Owens, L., Cobain, K., Fitzgerald,

R., Gilmore, I.T., Pirmohamed, M.

The University of Liverpool

Introduction

Growing burden from alcohol-related harm

A paucity of evidence for effectiveness of treatment

for alcohol dependent patients in acute settings

Need for investigation and robust testing of

treatment modalities

Need to provide clinical guidance

Alcohol: The burden in Liverpool, UK

Burden of alcohol to the UK NHS –

12% A&E attendances (Pirmohamed et al 2000)

26% Intensive care admissions (Owens et al 2001)

4th most common presenting problem in medical student case load

Alcohol: The burden in Liverpool, UK

Healthcare professionals and their attitudes –

Professional scepticism – nurses & doctors

Nurses are best placed to deliver interventions (Kaner 2004, Owens 2002)

Limited knowledge and confidence (Owens et al 2000)

Willingness to engage (Owens et al 2000, Brown et al 1997)

Nurse intervention models (RCP 2001)

Lack of structured response in acute hospitals (Owens et al 2005)

Method

Prospective cohort study (March 2007-March 2008)

2 UK NHS Hospital Trusts in NW of England

treatment site (N=100)

control site (N=100)

6 month follow-up

Recruitment simultaneous at two sites

Recruitment and treatment was by same Nurse

(ASN)

Results 1: Demographics

Intervention (%)

Control (%)

Female White BritishNo Fixed Abode Single Lives Alone Employed Smokes

24100105845983

34100736521567

Results 2: Presenting Complaint

Acute Alcohol WithdrawalGastrointestinal Cardiovascular Mental HealthNeurological Respiratory GenitourinaryMusculoskeletal Accident & Injury

Intervention1634193114229

Control122725111301110

Results 3: Difference in dependence baseline to follow-up

Control B

aseli

ne

Control F

ollow-up

Treatm

ent B

aseli

ne

Treatm

ent F

ollow-up

0

20

40

60

Seve

rity

of A

lcoh

ol D

epen

denc

e Q

uest

ionn

aire

Sc

ore

Results 4:Difference in alcohol consumption baseline to

follow-up

Contro

l Bas

eline

Control F

ollow-up

Treatm

ent B

aseli

ne

Treatm

ent F

ollow-up

0

50

100

150

Dai

ly A

lcoh

ol U

nits

Statistical Results: Control versus intervention

Reduced alcohol consumption (p = 0.0001)

Reduced AUDIT score (p = 0.0001)

Reduced SADQ score (p = 0.0001)

Less A&E attendances (p = 0.023)

Lower length of hospital stay (p = 0.0001)

* p values Wilcoxon

Limitations

Sample size

Non-generalizability

Conclusions

This research adds to the emergent evidence on

interventions for alcohol dependent patients in

acute hospital settings

BI may be an effective treatment for non treatment seeking

alcohol dependent individuals

BI are effective in reducing alcohol-related hospital

admissions, hospital length of stay

BI are effective in reducing alcohol consumption and

dependence

Nurses are ideally placed to deliver these interventions in

this setting

Acknowledgements

Professor M Pirmohamed

Dr k Cobain

Dr R Fitzgerald

J Higgins

S Chorley

Alcohol Lifestyles Team StaffPatients and staff at both hospital sites