Substance Misuse Alert
Cascade Protocol
Approved
Version
10/06/2011
Version 2
Date of First Issue
Review Date
Date of Issue
EQIA
Author / Contact
15 / 06 / 2011
Annually
18 / 04 /2012
Yes
Dr Henry Prempeh
Carol Crawford
Area Prevention & Control of Infection Committee
Group / Committee
- Final Approval
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Management of Policies Procedure control sheet
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Substance Misuse Alert Cascade Protocol
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published
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audience
NHSFV wide
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Consultation and Change Record – for ALL documents
Contributing Authors:
Dr Peter Bramley; Carol Crawford; Kevin Chase & Allyson
Blair; Dr Henry Prempeh; Elaine Lawlor; Jean Logan
Consultation Process:
Forth Valley Alcohol & Drug Partnerships; FVADP Health
Reference Group; FV Drug Related Critical Incident Group;
Public Health Consultants; BBV MCN Steering Group;
Substance Misuse Clinical Governance Prescribing Sub
Group; Medical Director, NHS Forth Valley; Care Groups,
Mental Health Specialties
Distribution:
Partnership agencies as listed in Appendix A
Change Record
Date
Author
Change
Version
April 2012
Carol
Crawford
Page 4
Final
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1.
Introduction
Over the last few years there have been an increasing number of incidents
associated with the use and misuse of drugs. These incidents range from new
legal or illegal drugs with unknown properties, to the misuse of prescription
drugs, as well as the risk associated with contaminated drugs.
Often, when information surfaces on these new harmful effects it is cascaded
between agencies with no clearly defined pathway. This protocol will define what
the cascade pathway should look like between the partner agencies within Forth
Valley.
2.
Scope
This process provides a pathway for communicating a response to messages
and alerts relating to substance misuse which may have a significant health risk
e.g.

Infectious risk

Other health risks, e.g. mental health issues

Adulterated substances

Purity issues
This protocol applies to all partner agencies as listed in Appendix A.
Each partner has a responsibility to support this process by sharing information
with Forth Valley Blood Borne Virus Managed Care Network (BBV MCN) in
addition to receiving and cascading information. Responsibility for overseeing
the effective implementation of this protocol and its evaluation sits with Forth
Valley BBV MCN
3.
Aim
The aim of this protocol is to protect the health of drug users and those who
support them within Forth Valley by providing a coherent and co-ordinated
timely response related to emerging drug issues. The context of this protocol
relates to the provision of information regarding health risk associated with illicit
drug use to users, drug workers, and other sources.
4. Definitions
It is expected that information related to health risk associated with illicit drug
use:

Will be shared with the Public Health Department of NHS Forth Valley as
soon as it is received by any partner agency.

Will be screened by the Public Health Department of NHS Forth Valley in
collaboration with cascade advisor (appendix A) where appropriate for
reliability based on content, source, and corroboration with relevant partner
agencies.
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


Will be cascaded in a timely fashion to relevant partners (appendix A)
Will be placed in a standardised format (appendix C)
Will meet the needs of all local agencies and service providers, as well as
those of clients/service users/general public.
5. Processing of Messages/Alerts: (IN)
Messages/Alerts may be generated by a variety of agencies, or they may arise
from anecdotal statements made by workers or users.
5.1 All messages received by any partner agency staff should be forwarded to
their manager.
5.2 The local agency manager (nominated person/service manager/key person)
should verify the information where possible before sending an e-mail to the
Substance Misuse Alert mailbox: FV-UHB.SubstanceMisuseAlerts@nhs.net. The
e-mail should contain in the Subject title: ‘Substance misuse alert’ + key
message, and acknowledge the information has been received.
5.3 Once a message is received by NHS Forth Valley Public Health it will be
examined against the following criteria:
 Content of the message and its relevance.
 The original source of the information and their reliability.
 Corroborating information from other sources in particular Central
Scotland Police.
5.4 Each relevant message will be given a High, Medium, Low or Information
Sharing coding and an initial cascade profile by Public Health before initiating the
cascade
 A High Alert message is of the highest importance due to demonstrated
health risk and originates from a reliable or corroborated source.
 A Medium Alert message may be of limited importance based on
potential health risk but originates from a reasonably reliable source. A
medium message requires discussion and confirmation by key partner
agencies.
 A Low Alert may be of limited importance based on potential health risk
and originates from an unreliable source that is not corroborated.
 An Information Sharing Alert is of limited importance based on
potential health risk, the message will be cascaded for information
dissemination from or to the substance alert mailbox. The purpose of this
alert is to have a robust two way system where local intelligence can be
shared / corroborated.
In circumstances, where relevant, an information sharing alert will be sent to
appropriate contacts as determined by the Cascade Lead or Deputy.
5.5
Sources which have been afforded an automatic High Alert status will
include:
 Scottish Crime & Drug Enforcement Agency (SCDEA)
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


Health Protection Scotland (HPS)
Scottish Drug Forum (SDF)
Scottish Government (SG)
5.6 Sources which have been afforded an automatic Medium Alert status
include:
 Treatment services
 Pharmacies
 All other recognised sources e.g. media, recognised websites and other
health boards.
5.7 The detailed list of sources is provided in Appendix B, this will be used in
the decision making process for Medium Alerts and stored in the database.
6.
Cascading of Messages/Alerts: (OUT)
6.1 A High Alert message will be cascaded immediately
6.2 A Medium Alert message, when confirmed by corroboration, will then be
cascaded.
6.3 A Low Alert message will not be cascaded, however the information will be
logged on the Substance Misuse Alert database.
6.4 An Information Sharing Alert will be cascaded to or from the substance
alert mailbox, this alert will act as a two way information sharing system
6.5 The BBV MCN Manager within Public Health will maintain the Substance
Misuse Alert Database.
6.6 FVADP support team will maintain the Communication cascade list. This will
be reviewed and updated quarterly.
7.
Public Information/Communications
The Public Health Department of NHSFV, FVADP and Central Scotland Police
will work jointly with their respective Communication Leads to provide accurate
information in a timely fashion to allow alerts to be disseminated to the relevant
agencies and the general public quickly and efficiently. Where appropriate, this
would include a joint media statement which would be drafted by the
Communication Leads following discussion with the appropriate service lead from
Central Scotland Police, NHSFV and FVADP. While this may include information
on sources of support and advice along with relevant telephone numbers, it is
important to remember that there is no guarantee that all of the information will be
used by the local media.
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Lead agencies would therefore also ensure that statements are publicised online
via the web and use social media to raise awareness of specific issues. A
nominated spokesperson would also be identified to respond to requests for
further information or interviews.
8.
Cascade Lead
BBV MCN Manager
9.
Cascade Deputies
BBV Project Manager (contact details appendix A)
Health Protection Nurse Specialist (contact details appendix A)
Consultant in Public Health Medicine (contact details appendix A)
10.
Advisors
Refer to appendix A
11.
Cascade Service Leads
Identified service leads are named in appendix A. It is the responsibility of
cascade service leads to disseminate the information to all relevant staff in a
timely manner, and also their responsibility to ensure that any alert received
when they are not on duty will be forwarded and actioned by a nominated deputy.
12.
Agreement Signatures
Contact details appendix A
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Appendix A
Cascade list for Substance Misuse Alerts
Cascade Officers
Job Title
Organisation
Tel Number
Mobile
Email address
Carol Crawford
BBV MCN Manager
Public Health
01786457235
07767494982
carol.crawford2@nhs.net
Ann McGregor
BBV Project Manager
Public Health
01786457278
07919110322
ann.mcgregor@nhs.net
Maureen Cornforth
Health Protection Nurse
Public Health
01786457240
07786197535
maureen.cornforth@nhs.net
Dr Henry Prempeh
CPHM
Public Health
01786457283
07710100033
henry.prempeh@nhs.net
Advisors
Job Title
Organisation
Tel Number
Mobile
Email address
Jean Logan
Lead Pharmacist
NHSFV
01786434762
07920711033
jean.logan@nhs.net
Elaine Lawlor
Forth Valley ADP
Coordinator
FVADP
01786434761
07810630618
elaine.lawlor@nhs.net
Dr Peter Bramley
Gastroenterologist
NHSFV
01786434079
07554439374
peter.bramley@nhs.net
Dr Claire McIntosh
CADs Psychiatrist
NHSFV
01786483111
07881846278
claire.mcintosh@nhs.net
P.C. Matthew Riddell
Central Scotland Police
Central Scot Police
01786456000/452207
N/A
informationandinterventions@centralscotland.pnn.police.uk
Drug & Alcohol Services
Managers
Organisation
Tel Number
Mobile
Email address
CADS
Eddie Sutherland
NHSFV
01786 483131
01786 483148
edwardsutherland@nhs.net
Addiction Recovery Services
Graham Nisbet
Graham Nisbet
01259 729687
07770816140
grahamnisbet@nhs.net
Criminal Justice Drug Treatment Service
Dot Mackie
Stirling Council
01786 443900
07717544759
mackied@stirling.gov.uk
Signpost Recovery
Norrie Moane
Norrie Moane
08456 731774
07848457485
norrie.moane@signpostrecovery.org.uk
Addiction Support Counselling
Paul Mooney
ASC
01324874969
TBC
chiefexec@asc.me.uk
Substance Misuse Child Care
Janice McCallum
Clacks Council
01259 225197
TBC
jmccallum@clacks.gov.uk
AXIS Young People Substance Service
George Mann
Barnardos AXIS
01324 718277
07584344574
george.mann@barnardos.org.uk
Barnardos Plan B (Prison Project)
Helen Jones
Barnardos AXIS
01324 722624
07990567557
helen.jones@barnardos.org.uk
Falkirk Council
01324 501060
Outreach Service, Clacks
Connect-Young People Service
mary.boyd@barnardos.org.uk
Barnardos
Mary Boyd
FVADP
Contact
Organisation
Tel Number
Mobile
Email address
FVADP
Anita Dufton
FVADP
01786 434763
N/A
anita.dufton@nhs.net
ADP - Falkirk
Caird Forsyth
Falkirk Council
01324 506045
07999840154
caird.forsyth@falkirk.gov.uk
ADP - Clacks
Valerie Corbett
Clacks Council
01259 452446
07837951751
vcorbett@clacks.gov.uk
ADP - Stirling
Elaine Brown
Stirling Council
01786 443427
07717545434
browne@stirling.gov.uk
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NHS (Corporate, Primary Care & Acute)
Managers
Organisation
Tel Number
Mobile
Clackmannanshire CHP
Kathy O'Neil
Clacks CHP
01259 290220
07900136853
k.oneill@nhs.net
Stirling CHP
Kathy O'Neil
Stirling CHP
01786 434780
07768145638
A/A
Falkirk CHP
Sue Dow
Falkirk CHP
01324 614656
07748111849
sue.dow@nhs.net
Local Intelligence Network
Gail Caldwell
Pharmacy
01786431210
07825843190
gail.caldwell@nhs.net
Communications dept NHSFV
Elsbeth Campbell
NHSFV
01786457264
Out of Hours
Karen Maclure
Stirling
01324566000
07920502617
karen.maclure@nhs.net
Out of Hours
Pam Calder
Clacks
01324566000
07766570976
pamelacalder@nhs.net
Out of Hours
Lynda Clayton Chapman
Falkirk
01324566000
07899650415
Lclayton-chapman@nhs.net
Acute Physicians
Via Sara Jamdar
NHSFV
01324 566679
Emergency Department
Karen Maclure
HNSFV
Medical Director
Iain Wallace
Hepatology Team
Dr Bramley
Communications-Kate Fawcett
Elsbeth Campbell
Email address
elsbeth.campbell@nhs.net
sarajamdar@nhs.net
07920502617
karen.maclure@nhs.net
Red cascade
01786 457 292
FV-UHB.hepatology@nhs.net
NHS Forth Valley
kate.fawcett@nhs.net
01786457264
GPs Clacks
NHS Forth Valley
FV-UHB.FVPC-GPsClackmannanCHP@nhs.net
GPs Falkirk
NHS Forth Valley
FV-UHB.FVPC-GPsFalkirkCHP@nhs.net
GPs Stirling
NHS Forth Valley
FV-UHB.FVPC-GPsStirlingCHP@nhs.net
Dr Oliver Harding
Public Health
01786 457265
oliver.harding@nhs.net
Dr Graham Foster
Public Health
01786 457 281
graham.foster@nhs.net
Dr Jennifer Champion
Public Health
01786 457 262
jennifer.champion@nhs.net
Dr AnneMaree Wallace
Public Health
01786 457 271
annemaree.wallace@nhs.net
Jonathan Horwood
Public Health
01786 457 257
jonthan.horwood@nhs.net
National
Contact
Organisation
Tel Number
Mobile
Email address
Scottish Prison Service
Ruth Parker
SPS
0131 2248635
N/A
ruth.parker@sps.pnn.gov.uk
Scottish Ambulance Service
Jim Dickie
SAS
07810180817
08456023999
j.dickie@nhs.net
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Drug Message/Alert Assessment Table
Appendix B
Status Key. A High alert message is of the highest importance due to a demonstrated health risk and originates from either a reliable or corroborated source.
A Medium alert message is of limited importance based on potential health risk but originates from a reasonably reliable source but with no corroboration. A Low
alert message is of no significant health risk and is from an unreliable source that is not corroborated.
Message No:
Message Status:
HIGH - MEDIUM - LOW
Format
Sources
Version 2
√
Verbal=V;
Letter=L;
E-mail=E-m
Reliability of
originating source
Reliable:
Unsure:
Not reliable:
Corroborating Source
1
2
3
√
Health Protection Scotland (HPS)
HPS
Scottish Government (SG)
Scottish Crime Drug Enforcement Agency
(SCDEA)
SG
Scottish Drugs Forum (SDF)
SDF
CADS
CADS
Out of hours
Out of hours
GPs
GPs
Signpost
Signpost
Acute Clinicians
Acute Clinicians
Pharmacists
Pharmacists
Neighbouring Boards
Neighbouring Boards
SPS
SPS
Criminal Justice
Criminal Justice
Mental Health
Mental Health
Liaison psychiatrist
Liaison psychiatrist
Police
Police
A&E
A&E
Other
Other
18th April 2012
Distribution list
SCDEA
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√
ALERT e-mail No
LOW ALERT
Scope
This process is a pathway to communicate alerts relating to substance
misuse which may have a significant health risk
A Low Alert message is of no significant health risk and may be from an
unreliable source that is not corroborated
Subject
Title
Sent to
Substance Misuse Alert
FV-UHB.SubstanceMisuseAlerts@nhs.net
Sent by
Blood Borne Virus Managed Care Network
Date
Action(s) Please cascade to relevant staff.
required
Alert ends
Carol Crawford
BBV MCN Manager
carol.crawford2@nhs.net
Final version
29/08/2012
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ALERT e-mail No
MEDIUM ALERT
Scope
This process is a pathway to communicate alerts relating to substance
misuse which may have a significant health risk.
A Medium Alert message is of limited importance based on potential health
risk but originates from a reasonably reliable source. This alert may only be
relevant to certain agencies for information and awareness raising locally.
Subject
Title
Sent to
Substance Misuse Alert
FV-UHB.SubstanceMisuseAlerts@nhs.net
Sent by
Blood Borne Virus Managed Care Network
Date
Action(s)
required
Alert ends
Carol Crawford
BBV MCN Manager
carol.crawford2@nhs.net
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ALERT e-mail No
HIGH ALERT
Scope
This process is a pathway to communicate alerts relating to substance
misuse which may have a significant health risk.
A High Alert message is of the highest importance due to a corroborated,
demonstrated health risk
Subject
Title
Sent to
Substance Misuse Alert
Sent by
Date
Action(s)
required
Blood Borne Virus Managed Care Network
FV-UHB.SubstanceMisuseAlerts@nhs.net
Alert ends
Carol Crawford
BBV MCN Manager
carol.crawford2@nhs.net
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ALERT e-mail No
INFORMATION SHARING ALERT
Scope
This process is a pathway to communicate alerts relating to substance
misuse which may have a significant health risk
The Information Sharing Alert is a two way information sharing system of
any relevant information between local services and the substance alert
mailbox.
Subject
Title
Sent to
Substance Misuse Alert
Sent by
Date
Action(s)
required
Blood Borne Virus Managed Care Network
FV-UHB.SubstanceMisuseAlerts@nhs.net
Alert ends
Carol Crawford
BBV MCN Manager
carol.crawford2@nhs.net
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I agree to participate in the Substance Misuse Alert Cascade Protocol and
disseminate the information to all relevant staff members.
Organisation
NHSFV
Manager
Dr AnneMaree
Wallace
Elaine Lawlor
Date
Signature
29/07/2011
Central Scotland
Police
David Flynn
18/08/2011
Medical Director
Dr Iain Wallace
25/08/2011
ADP
02/08/2011
.
Final version
29/08/2012
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Publications in Alternative Formats
NHS Forth Valley is happy to consider requests for publications in other language or
formats such as large print.
To request another language for a patient, please contact 01786 434784.
For other formats contact 01324 590886,
text 07990 690605,
fax 01324 590867 or
e-mail - fv-uhb.nhsfv-alternativeformats@nhs.net
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