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#Post#: 26--------------------------------------------------
Alcohol Care team initiative implementation details
By: admini5 Date: April 16, 2015, 5:19 am
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What are the implementation details for Alcohol Care Team
initiative?
Alcohol Care Teams and lead consultant
Each multidisciplinary Alcohol Care Team is led by a consultant,
with both a clinical and strategic role and five dedicated
sessions weekly, who also collaborates with public health, PCOs,
patient groups and key stakeholders to develop and implement a
district alcohol strategy.
Each district general hospital has an Alcohol Care Team. This is
a formalised group of individuals, with an overall lead
clinician. It includes a lead from hepatology, gastroenterology,
psychiatry, A&E and acute medicine, other key specialist leads,
the lead alcohol specialist nurse and an executive member of the
trust board, with a locally appropriate balance of
representatives from primary care and patient groups.
The Alcohol Care Team works closely with PCOs, key stakeholders
and patient groups to develop and deliver a strategy for
reducing alcohol‐related problems in the district.
Patient groups are encouraged and supported to develop their own
pathways of care, in collaboration with service providers.
The lead clinician has shared responsibility, with public health
and primary care, for delivering timely and responsive
high-quality support services and achieving targeted quality
metrics, including:
-
and mortality
-
-
The lead clinician is usually a hepatologist, gastroenterologist
or liaison psychiatrist, but could be an acute medicine
physician or A&E consultant, or a doctoral-level nurse
consultant. The lead clinician identifies individuals
responsible for alcohol policy, with a dedicated clinical
session, in key clinical areas.
The lead clinician has the skills and knowledge to be able to
develop, implement, monitor and evaluate effective treatment
pathways across disciplines and services, and the ability to
provide clinical supervision and support to a range of care
providers of different professional groups and specialties. The
lead also provides clinical expertise to policy makers at local,
regional and national level.
The Royal Bolton Hospital
The Royal Bolton Hospital collaborative care for alcohol-related
liver disease and harm is a multidisciplinary team. Prior to
2012, it consisted of 4 consultant gastroenterologists, a
liaison psychiatrist, one psychiatric alcohol liaison nurse, one
liver nurse practitioner and all relevant healthcare
professionals, including a dedicated social worker, who greatly
influences the average length of stay and facilitates discharge
of patients into a suitable environment(Moriarty 2011).
In January 2012, the Royal Bolton Hospital appointed two more
nurses and established a hospital-based 7-day alcohol specialist
nurse service. The total cost of the four nurses and secretarial
support was £198,125. The service will be evaluated in terms of
hospital mortality, length of stay, patient engagement and risk
management.
The alcohol specialist nurses, on a daily basis, jointly assess
all alcohol-related admissions, provide brief advice to patients
and initiate care plans. Patients are offered rapid outpatient
appointments with the Community Alcohol Team, and/or
detoxification starting in the hospital. The nurses run their
own liver disease course for staff and a network of 50 alcohol
link workers throughout the Trust has been established.
Prior to 2012, when there were just the two specialist nurses,
working in partnership, inpatient detoxifications were reduced,
saving the Trust more than 1000 bed days annually, equivalent to
£250,000 in reduced admissions alone.
An additional role of alcohol specialist nurses is to improve
risk management, with fewer clinical incidents and assaults on
other patients and nursing staff. These incidents often occur at
weekends and at night, when nursing cover tends to be lowest.
This leads to increased staff sickness, damaged morale and
sometimes the loss of dedicated, skilled gastroenterology
nurses.
Allied to this, the alcohol specialist nurses supervise and
optimise the care of all inpatients on the gastroenterology ward
and also discuss all new admissions to the Acute Medical Unit at
the multidisciplinary meeting, which follows the daily
consultant ward round.
The gastroenterology consultant then sees these patients on the
acute unit, ensuring rapid assessment and treatment and the
selection and prioritisation of appropriate patients for
transfer to the gastroenterology ward.
New way of working: In order to cope with the large numbers of
inpatients with alcohol-related problems, the four
gastroenterology consultants now work in 2-week blocks on the
ward. They do daily ward rounds, have daily multidisciplinary
team meetings and see all acute medical admissions and ward
consultations. Consequently, there has been a 37% increase in
ward discharges; length of stay has fallen from 11.5 days to 8.9
days, and mortality from 11.2% to 6.0%. The downside has been
that, during these 2 weeks, the consultant on the ward loses 10
endoscopy and outpatient clinic sessions (Singh et al. 2012).
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