Post on 04-Jan-2016
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