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Nurse-Led Alcohol Services. A Liverpool Case Study

Nurse-Led Alcohol Services. A Liverpool Case Study. NHS. 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.

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Nurse-Led Alcohol Services. A Liverpool Case Study

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  1. Nurse-Led Alcohol Services.A Liverpool Case Study NHS

  2. 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.

  3. Nurses best placed; but they come in many guises

  4. 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.

  5. Understanding partner needs • Agree local guidelines to support referrals to nurse led clinics. • Agree local guidelines to support referrals from nurse led clinics.

  6. Practical Issues • Nurse responsibilities • Nurse autonomy • Nurse safety • Patient expectations • Multidisciplinary expectations –role legitimacy

  7. All that done; how do we know who are the essential players?

  8. A prospective controlled cohort study:Brief Interventions for alcohol dependent patients in an acute hospital setting Authors: Owens, L., Cobain, K., Fitzgerald, R., Gilmore, I.T., Pirmohamed, M. The University of Liverpool

  9. 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

  10. 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

  11. 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)

  12. 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)

  13. Results 1: Demographics

  14. Results 2: Presenting Complaint

  15. Results 3: Difference in dependence baseline to follow-up 60 40 Severity of Alcohol Dependence Questionnaire Score 20 0 Control Baseline Control Follow-up Treatment Baseline TreatmentFollow-up

  16. Results 4:Difference in alcohol consumption baseline to follow-up 150 100 Daily Alcohol Units 50 0 Control Baseline ControlFollow-up Treatment Baseline Treatment Follow-up

  17. 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

  18. 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

  19. Professor M Pirmohamed Dr k Cobain Dr R Fitzgerald J Higgins S Chorley Acknowledgements Alcohol Lifestyles Team Staff Patients and staff at both hospital sites

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