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
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.
Admissions rate/100,000
Actual
3500
3000
Projected
Actual
Projected
2500
2000
1500
1000
500
0
Knowsley
England
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 inpatient 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?