Development of alcohol liaison within the Royal Devon and Exeter hospital Sally Jarmain Clinical Lead in Alcohol

Why bother? 12% of A&E attendances are alcohol related (Pirmohamed, 2000) 34-36% of orthopaedic admissions and 33-50% of head injury patients are drinking at hazardous levels (Chick, 1991) 20% of patients admitted for non-alcohol related reasons are drinking at harmful levels (RCP, 2001) Hospital admissions for the 3 main alcohol-specific conditions (mental health, liver disease and acute intoxication) has doubled in the last 10 years (National Audit Office, 2008)

Royal College of Physicians (2001) Alcohol: Can the NHS afford it? Screening tools to be used to detect problem drinkers; A recognised management plan and established protocols to be developed; Pharmacology pathways to be used to ensure safe detoxification; Concurrent vitamin therapy to be administered to patients with alcohol-related problems; Alcohol education and training to be given to hospital staff to improve their practice with and attitudes to this patient group; Appropriate counselling and onward referral to be offered to patients; Alcohol liaison nurses to be appointed within all acute hospitals to effect the above recommendations and raise the issue of alcohol- related administration and governance.

Aims of Project Encourage hospital staff to screen patients using a screening questionnaire Give brief advice where appropriate Provide advice and information to medical/nursing staff on the management of people with alcohol problems Reduce hospital bed days by facilitating community detoxification where appropriate

Development of post within RD&E so far... Communication about role Screening tools Care pathways Guidelines

Screening tools Paddington alcohol test Fast Audit Others e.g. MAST, Cage

ICP following referral to Liaison Nurse Referral received by alcohol liaison nurse. Patient will be triage assessed on the ward, within 1 working day of the referral being received. Assessments will normally take place during the morning. Does client want to be seen by alcohol service? Yes No Is the client dependant on alcohol? Provide “Sensible drinking” and “Addaction” leaflets. Give brief advice on reducing alcohol consumption Yes No Is the client currently prescribed medication for alcohol detoxification (including medication for delirium tremens or alcohol-related hallucinosis)? Does the client have complex needs? (learning disability, repeated presentations at A and E for suicidal ideation, a mental health care manager or child protection issue) Yes No Yes No Is the client drinking at a harmful or hazardous level? Alcohol liaison nurse will offer monitoring and support for client whilst they remain in hospital and will assess suitability for community detoxification if appropriate. Client will be referred for ENDAS keyworker by alcohol liaison nurse. Yes No Alcohol liaison nurse will refer to Addaction and provide “sensible drinking” and “Addaction” leaflets. Provide “Sensible drinking” leaflet. Give brief advice on reducing alcohol consumption Following detoxification or discharge from hospital (whichever happens first), client will be referred by liaison nurse to ENDAS keyworker for relapse prevention work. Liasion nurse will continue to offer support to client until a keyworker is allocated.

Outcomes 16 38 39 14 9

Learning and future development Audit Changes to referral system/care pathways Development of guidelines Training Increasing wards covered by nurse A&E

Contact details Sally Jarmain (Clinical lead in alcohol) Endas Wonford House Hospital Dryden Road Exeter EX2 5AF Tel: 01392 208210 Sally.jarmain@nhs.net