A Protocol for Completion of Hospital Initiated
Alcohol Detoxification.
Developed by,
Bolton Community Alcohol Team
(Greater Manchester West NHS Mental Health Foundation
Trust)
Pharmacy Department (The Royal Bolton Hospital NHS
Trust)
Liver Specialist Nurse (The Royal Bolton Hospital NHS
Trust)
Aims
To provide a safe treatment procedure for the management of
withdrawal from alcohol in the home environment for those
patients/clients whose medical treatment no longer requires
hospitalisation.
To provide adequate support for clients, Tier 3 Specialist
Services (MoCAM) when detoxification from alcohol is
complete.
1. Criteria
The person must,
1:1 Be physically dependent on alcohol and require the prescription of
medication to control any withdrawal symptoms.
1:2 Have remained in hospital for not less than 2 days and no longer
require hospital inpatient treatment for any concurrent physical
disorder.
1:3 Be living in a supportive environment where there is adequate and
suitable social support.
1:4 Not be suffering from serious physical or mental health illness
which could jeopardise the safe completion of a community
detoxification e.g. high risk of self – harm, misuse of drugs, unstable
epilepsy or a history of delirium tremens.
1:5 Not have undergone more than 2 previous detoxifications from
alcohol in the last twelve months.
1:6 Agree to abstain from alcohol throughout the period of detox.
1:7 Allow daily home visits by the Community Alcohol Team for
monitoring and advice.
2. Referral and Process
2:1 The ward/unit based nursing/medical staff will refer to The
Alcohol Liaison Nurse Service for assessment.
2:2 The referral must be made between the hours of 9am and 5pm
Monday – Friday.
2:3 The Liaison Nurse will assess for suitability and gain agreement
from the patient’s/client’s G.P.
2:4 The Liaison Nurse, will agree an appropriate reducing regime of
medication with the Hospital Physician.
2:5 The Pharmacy Department will supply the patient/client with the
medication and instructions.
2:6 The patient/client will sign a contract agreeing to the terms of the
detoxification (appendix 1)
2:7 The Liaison Nurse, will communicate with the duty Worker from
the Community Alcohol Team who will allocate a team member to
supervise the detoxification.
3. The Community Detoxification Process.
3:1 The Community Alcohol Team will visit the patient/client at home
within 24 hours of discharge from hospital (i.e. if the discharge is in
the afternoon the CAT will visit the following morning.)
3:2 The key worker from the Community Alcohol Team will agree a
care plan detailing post-detoxification support at the initial visit.
3:3 The Community Alcohol Team, will perform the following checks
at each visit,
Severity of withdrawal symptom checklist
Monitoring of medication
Monitoring of blood pressure and pulse
Monitoring of breath or blood alcohol concentration
3:4 The Community Alcohol Team, will inform the Client’s G.P.,
Consultant and/or any other relevant health or social care providers
the outcome of the detoxification.
Role of Pharmacy
The Pharmacy Department will dispense chlodiazepoxide for
patients, deemed as suitable by the Alcohol Liaison Service, to
complete alcohol detoxification under the Supervision of Bolton
Community Alcohol Team.
1. Prescriptions will be written between 9.00am and 5.00pm, Monday
to Friday when the Alcohol Liaison Service is available.
2. A maximum of five days treatment will be supplied.
3. A maximum of 80mg of chlodiazepoxide in the first 24 hours of the
patient being discharged will be dispensed.
4. No “when required” doses are permitted.
5. Prescriptions must be countersigned by a member of the
Community Alcohol Team.
The Community Alcohol Team Liaison Staff are,
Emma Dermody, Senior Substance Misuse Practitioner (Alcohol
Liaison Nurse.)
Amanda Haigh, Senior Substance Misuse Practitioner
In their absence the following Senior Substance Misuse Practitioners may provide
cover
Nicola Liggett, Senior Substance Misuse Practitioner
Michelle Kellett, Senior Substance Misuse Practitioner
Heather Davis Senior, Substance Misuse Practitioner.
(Appendix 2)
Procedure
1. Reducing regime of chlodiazepoxide must be prescribed on the
Trust’s discharge summary (R282) by:
a) a medical practitioner.
or
b) Sandra Crompton, Liver Specialist Nurse (Nurse Prescriber). The
form must be agreed and countersigned by a member of the
Community Alcohol Team.
The form must be agreed and countersigned by a member of the
Community Alcohol Team
2. The prescription must clearly indicate the dose, time and dates of
administration of chlodiazepoxide.
3. The Alcohol Liaison Nurse/ Liver Specialist Nurse will liaise with
the ward pharmacist/technician to discuss and organise the
dispensing of the prescription.
4. The reducing dose must be clearly written on a variable dose
medication card, by the pharmacy staff. A chlodiazepoxide patient
information leaflet must be supplied.
5. On receipt of the medication, the patient must be counselled by a
member of the Community Alcohol Team.
Under no circumstances will The Pharmacy Department dispense
a prescription without the agreement of the Alcohol Liaison
Nurse.
Appendix 1
Client Contract and Consent Form for Continuation of
Detoxification from Alcohol in the Community.
Please read, sign and date this form as confirmation that you
Wish to have a detoxification from alcohol completed at
home, that the procedure has been explained to you and
you agree to comply with the following conditions;
 you will not drink alcohol during the agreed period of
detoxification and agree to be breathalysed, when
asked, by the Community Alcohol Team.
 You will take the medication prescribed, as instructed
and return any unused medication to your local
pharmacy for disposal.
 You will allow your blood pressure, puilse and
temperature to be recorded.
 You will allow the Community Alcohol Team to
communicate the details of your detoxification to your
G.P.
Signature ……………………….patient/client.
Date …………………………….
Signature ……………………….Alcohol Liaison Nurse
Date ……………………………..
Appendix 2
Contact Details and Confirmation of Community
Alcohol Team Staff Members.
The Alcohol Liaison Nurse can be contacted by;
Pager
Answer Machine (Royal Bolton Hospital)
Bolton Community Alcohol Team
Giles House
43 Chorley New Road
Bolton
BL1 4QR.
01204 390295
01204 380948
The Pharmacy Department will be provided with a letter confirming
the members of staff at the Community Alcohol Team Staff.
The letter will be on headed paper and signed by the Team Manager at
the Community Alcohol Team.
The Pharmacy Department will be informed of any staff changes, by
letter from the Team Leader at the Community Alcohol Team.
The Community Alcohol Team will provide The Pharmacy
Department with sample signatures as per Royal Bolton Hospitals
NHS Trust Policy.