WORKSHOP B ALCOHOL SERVICE KNOWSLEY Michele White Madeline Jones Elizabeth Gibbons

WORKSHOP B

ALCOHOL SERVICE KNOWSLEY

Michele White

Madeline Jones

Elizabeth Gibbons

• Alcohol is responsible for 6% of ALL hospital admissions.

• 459,836 admissions in 2005/06• 811,433 admissions in 2006/07

• Rising by around 80,000 admissions a year

SOURCE: ALCOHOL LEARNING CENTRE

• Alcohol misuse contribute to 48 conditions

• 13 conditions wholly attributable to alcohol consumption

• 35 conditions partially attributable to alcohol consumptions

SOURCE: ALCOHOL LEARNING CENTRE

• Areas of higher deprivation have:-

• 2-3 times higher loss of life

• 2-5 times more admissions to hospital

SOURCE: ALCOHOL LEARNING CENTRE

Knowsley has had higher rates of hospital admissions for alcohol related

harm than the North West and England since 2002/03.

The rate for alcohol related harm has increased by 55% since 2002/03

where it is now at its highest point of 2479 per 100,000 population in

2007/08.

  Actual Knowsley

  Projected

  Actual England

  Projected

Across Merseyside, Knowsley has the second highest admission rate for

alcohol related harm.

PCT RATE PER 100,000 POPULATION

LIVERPOOL 2612

KNOWSLEY 2479

WIRRAL 2384

HALTON & ST HELENS 2143

SEFTON 1938

INCREASING RISK DRINKERS

24,988

HIGER RISK DRIKERS 8,684

DEPENDENT 4,776

BINGE 27,997

• Alcohol Service Knowsley is an alcohol service provided by alcohol specialists that can be accessed by Knowsley residents over the age of 18

• Service is run by Merseycare addiction services, commissioned by Knowsley Primary Care Trust

Team Structure• Specialist team manager: Michele White• 2 Deputy managers• 2 Hospital Alcohol Workers• 2 Community alcohol nurses• 3 Community practitioners• 1 IAPT worker• 1 Support worker• 1 Admin worker

What does Alcohol Service Knowsley provide?

•Comprehensive alcohol assessment•1-6 Cognitive Behavioural Therapy based goal orientated treatment sessions•Community detoxification or link in to in-patient detox at Windsor clinic for those not suitable•Hospital Alcohol Service (Whiston &UHA)•Link with probation service providing the treatment element of an Alcohol Treatment Requirement

What does the service provide cont……

•Relapse prevention•Harm reduction•Complementary Therapies•Family support•Links to other agencies/services•Training

Team Structure

• 3 staff across 2 acute trusts• 2 band 6 nurses, 1 band 5 nurse• Staff are all part of the ASK team

Objectives

• Identify A/E attendees with alcohol misuse• Provide brief advice and education re alcohol• Provide a detox management plan• Bridge gap between hospital and community• Provide training for hospital staff

Key Performance Indicator

• To be measured on:– Caseload per nurse– Number referred to BTC– Number hospital staff trained– Number of re attendees– Number hospital initiated detoxs

Training

• To build a service presence and awareness over 2 acute trusts

• Liaison with ward staff• Increase alcohol awareness• Collaborative working with existing services

Care pathway

• Agree clinical care pathways• Evidence based• Quality assured• Responsive to needs of service users

Daily

• Visit A/E ,Obs , MAU,GPAU• Offer advice re detox• Bridge services for clients• Liaise with existing services• Triage,screen,brief advice• Engage clients prior to discharge• Liaise with team colleagues • Available daily Mon - Fri

The Story So Far…..

Identification / Screening

• AUDIT FAST or PAT?

• Same both sites?

• Fit in with existing services

• Future plans to work with A&E managers to screen all patient

• Brief

Detox• Early discharge protocol agreed

for 1 trust• Plan to commence detox in

acute trust and complete in community following discharge

• Patients are admitted because they are ill!!!

• Specialist detox care plan

Challenges

• 2 acute trusts to serve• Other teams already on

site - streamlining• Acute staff expectations

that all teams work to same remit

• Need for honorary contracts

• Data collection – tracking readmissions

No honorary contract?• Permission to speak to patients• Access to acute trust computer

system• How watertight is care plan if staff

not recognised by hospital• Legality to access case notes• Vicarious liability work with for

acute trust patients• Discharge acute trust patients

What’s working• Positively received by hospital staff &

ASK team• Capturing patients who tend not to

access services (Brown 2006)• Patients referred receive specialist

in-patient care plan and/or Brief Advice

• “Teachable Moment” (Williams et al 2005)

• Better patient journey• Patients leave hospital with care plan

What’s working cont• Improved liaison with

hospital staff• Increased identification

alcohol problems – training• Team maintain contact

with clients while in hospital

• HALs clinics – fast treatment access - improved engagement to treatment (Williams et al 2005)

Summary• New project set up to meet particular

local needs• Comprehensive service specification

on 2 year pilot period • Performance indicators to demonstrate

quality• Some issues to deal with - the story

goes on….

Questions

Comments

Suggestions

Which screening tool is the most practical for use in emergency

departments?