CSNB334 Advanced Operating Systems 7. File Management

1. Alcohol Use: Identification, Brief Advice and Support Julie Spencer-Bennett and Julia Gasser Alcohol Liaison Nurse Specialists Alcohol Use – How YOU can make a difference: Identification and Brief Advice Julie Spencer-Bennett and Nicola Worrall

2. Housekeeping

3. Introductions Introduce yourself and state what experience you have had of alcohol in your area of work.

4. 4 simple steps 4 Manage Withdrawal 3 Refer (when appropriate) Units 1 Assess 2 Brief advice Refer to ALNS Admission document AUDIT – C Give brief advice Give info leaflets CIWA-ar

5. Why bother? 34 of our admissions each day are directly related to alcohol misuse (roughly equal to 1 ward) Highest level of liver disease in England and Highest number of alcohol-related deaths in England Alcohol related deaths far exceed the national picture by on average 3 times 1 in 5 hospital admissions = drinking at increasing risk levels Over 20,000 A&E attendances per year are due to alcohol ALL TEACHABLE MOMENTS Over 35,000 of day-case / inpatients = drinking at high risk or increasing risk levels Over 4500 hospital admission per year are alcohol-related 77% of domestic violence is estimated to be alcohol related

6. Friends and family Relationship problems, parental neglect, abuse Impact of alcohol Workplace Absenteeism, accidents, performance Housing Tenancy problems, Financial Expense; unemployment Personal safety Risky behaviour Cost to society Revenue Source of income & employment Health Physical health, mental health Crime Arrests, drink driving, domestic violence

7. Risks associated with drinking Cognitive Functions memory loss, Korsakoffs, Wernickes Cancers Breast, mouth, throat, oesophagus, stomach etc Behavioural Issues Violence, aggression Cardiovascular System weAkness of heart muscle, hypertension, heart failure, strokes, heart attacks Neurological System mental aspect: confusion, promiscuity and risk taking Neurological System physical aspect: loss of muscle control, impaired sensation leading to falls, trembling hands and tingling toes, neuropathy, numbness, painful nerves Gastrointestinal System Ulcers, inflammation of stomach, impaired blood clotting, liver damage, vomiting Pancreatitis Immune System frequent colds etc Sexual Health / Fertility Impaired sexual performance, increased risk of miscarriage, low birth weight babies, FAS Nutritional Deficiency Vitamin Deficiency, weight gain or loss, diarrhoea, malnutrition Mental Health Issues depression, nervousness

8. Alcohol-related harm Liver Cirrhosis 13X 13X Mouth Cancer 5.4X 5.4X Larynx Cancer 4.9X 4.9X Oesophageal cancer 4.4X 4.4X Hypertension 4.1X 2X Liver Cancer 3.6X 3.6X Haemorrhagic Stroke 3.6X 3.3X Coronary Heart Disease 1.7X 1.3X Ischaemic Stroke 1.8X 1.4X Breast Cancer 1.6X

9. Units of Alcohol • What is a unit of alcohol? 1 unit = half pint beer (3.5% alcohol) 1 unit = single spirits (25ml @ 40% alcohol) 1 unit = 1 glass wine (125 ml @ 8% alcohol) However, standard drinks differ to this…

10. Units made simple! Pint of beer / lager / cider 3 units Pub measure of spirits 1 unit Pint of strong beer / lager / cider 4-5 units Home measure of spirits 2-3 units 1 litre bottle of cider 5-9 units Bottle of spirits 30-40 units Glass of wine 3 units Bottle of alcopop / beer etc 1.5 units Bottle of wine 10 units

11. What is a “safe” limit? – i.e. the Government’s recommended guidance for sensible drinking Alcohol – Safe Limit Under 18s There is no known safe limit. DoH guidance suggests no alcohol at all for under 15s.

12. Short term benefits of reducing alcohol intake Lowers blood pressure Feel brighter and less sluggish Lose some weight Lose some weight Less arguments with family / friends Less hangovers! More productive at work / home Eyes look brighter – less puffy / red Save money – spend on other things More energy Less colds / chest infections – improved immune system Skin looks healthier

13. Risk Levels . Women

14. Documentation odd drink Step 1 - Assess a lot occasionally minimal a bottle 15 units every day Socially +++ a tipple regularly

15. Identification Tools AUDIT AUDIT-C

17. Step 1- Assess

18. Alcohol Care Pathway Complete AUDIT-C Patient scores 5 – 7 Patient scores less than 5 Patient scores 8-12 Give brief advice. Consider referral to ALNS. Give ‘Drink less...’ leaflet Refer to ALNS Assess need for treatment. Prescribe as per policy Record in notes Support from community alcohol services: • Refer to ALNS to make appt for discharge • Give leaflet / tel no for self-referral

19. Step 2 – Brief Advice BA can be split into simple and extended Well researched and evaluated as effective Simple BA – 5 mins Extended BA – 30 mins followed by other appointments 1 in 8 make changes to their drinking BA can help clients reduce their alcohol consumption by up to 20%.

20. Step 2 – Brief Advice Feedback Give an explanation of AUDIT score and risk level F Responsibility Place responsibility on the patient to make changes R Advice Advise the patient to cut down or abstain A Menu Ask patient for their ideas of ways to cut down and give suggestions M Empathy Show understanding and empathy towards the patient E Self-efficacy Encourage and reinforce the patients belief that they can make changes S

21. Step 2 – Brief Advice ACTIVITY – WAYS TO CUT DOWN If someone drinks above the sensible levels, what simple, achievable tips could you give them to help them reduce their alcohol intake?

22. Ways to cut down Introduce alcohol free days Start with one and build up to two or more Make a swap Try an alcohol free drink for a change e.g. smoothie Make it more difficult Leave the wine bottle in the kitchen so it takes more effort to top your glass up! Reduce glass size or measure Choose a smaller glass / drink halves or shandy / drink singles instead of doubles Reduce the strength Try drinking alcoholic drinks that are lower in strength (look at the ABV %) Be unit / calorie aware Use your free measure / spinner to raise your awareness of how much you are drinking Find a different hobby Try something new that doesn’t involve the pub! Alternate your drinks Drink water in between alcoholic drinks

23. Step 2 – Brief Advice ACTIVITY – GIVING BRIEF ADVICE Look at the scenario and decide as a group what the AUDIT score would be. Discuss what you would say to give brief advice to this person.

24. It may be best if you make changes to your drinking behaviour now whilst you still have a choice. Step 2 - Very brief advice30 seconds I think that it may help you feel better if you reduced your alcohol intake. Your condition may be linked to your alcohol intake so you should consider cutting down. If you don’t do something about your drinking now, you may be back in hospital soon

25. Things people may say… It’s only in the evenings that I have a drink. Everyone does that! I don’t drink first thing in the morning so my drinking is not a problem I only drink alcohol at the weekends I only drink 2 glasses of wine a night / My husband only drinks 4 pints of beer a night. I can’t understand why I can’t lose any weight

26. Step 3 - Referrals Range of options to refer to ALNS Bleep: 766 (Julie), 465 (Julia), 765 (Jess), 230 (Simon) Telephone: ALNS office (01253 303943) Referral book: Add sticker * Please provide AUDIT-C Score or level of alcohol consumption (units) when you make a referral*

28. Tel: 01253 311431

31. Tel no. 01253 476010

33. Range of options to refer to Community Services Option 1: ALNS The ALNS can make referrals and ensure appointment prior to discharge Option 2: Self Referral Give the patient contact details of the service (Give contact number and call the ALNS to ensure follow-up) Option 3: Staff referral You can complete a referral form if necessary Community Services If patient declines referral, give leaflets with Community Alcohol Services contact details for future consideration.

34. Step 4- Manage Withdrawal

35. Step 4- Manage Withdrawal If you suspect a patient is alcohol dependent and is at risk of withdrawal, refer to the Alcohol Withdrawal Syndrome policy and contact the ALNS as soon as possible

37. Ensure a nutritional assessment is carried out Use Clinical Institute Withdrawal Assessment (CIWA-Ar) tool to assess and treat symptoms Prescribe IV Pabrinex for 3 days (2pairs TDS), then oral vitamins Step 4- Manage Withdrawal Start Chlordiazepoxide immediately & PRN medication to prevent Alcohol Withdrawal Refer to the Alcohol Liaison Nurse Specialists If you suspect a patient is alcohol dependent and is at risk of withdrawal, refer to the Alcohol Withdrawal Syndrome policy and contact the ALNS as soon as possible

38. What can you do to help? Assess Advice Refer