Date post: | 26-Dec-2015 |
Category: |
Documents |
Upload: | anabel-rich |
View: | 216 times |
Download: | 0 times |
ALCOHOL CARE MODEL (1990-ONGOING)
Pioneered, Sustained, Evolving
Patient-Centred, Seamless, Holistic
Collaborative Gastroenterology / Psychiatry / Community
Teamworking
Governance
Audit, Research
Training, Education
Health Promotion
Impact / Replicable
1990Established Multidisciplinary Team
Weekly (1-2) Discuss Inpatients
Nurses, Doctors, Dietician, Physio, OT, Pharmacist, Chemical Pathologist, Speech Therapist, Asian Link Worker, Social Worker (Critical)
Optimised, Unified Care
Facilitated Discharge Planning
Everyone Valued
Teamworking Ethos
1993
WENDY DARLING
- Consultant Psychiatrist
- Substance and Alcohol Misuse
JOINT INPATIENT CARE
SIMULTANEOUS ALCOHOL CLINIC
- Monthly
INITIAL PROBLEMS / PREJUDICES OVERCOME
NIGHTINGALE WARDS
- Risk Management, Privacy
- Ward Drinking, Drug Misuse
- Advocated / Planned GI Ward
- Opened 2007
- 8 Side Rooms
SELF-INFLICTED DISEASE – Non Judgmental
REMOVED STIGMA
- Asian Community Elders
1998 – DAVID PROCTOR – PSYCHIATRIC LIAISON NURSE
Hospital/Community
MDT Member
Brief Interventions
A&E, Acute Admissions, Gastroenterology, Psychiatry, Orthopaedics
Firefighting
HCP Training, Education, Screening Strategy
Joined Simultaneous Alcohol Clinic
- 2 per Month
- Facilitated Communication
- Reduced DNA’s
DAVID PROCTOR (P.L.N) IMPACT
PATIENTS’ RESOURCES
- Asian
LIAISON
- GP’s
- Rapid Response Community Detoxifications
- C.A.T.
- Other Agencies
METICULOUS AUDIT/RESEARCH DATA
- Alcohol Misuse In Older People (2006)
Collaboration Cabinet Office Strategy Unit
- Wernicke-Korsakoff Syndrome (2007)
2006
Sandra Crompton Medical Liver Nurse Practitioner
Partners Emma Dermody, Hospital / Community P.L.N.
Gastroenterologist / Psychiatrist Supervision
Monday - Friday, 8am. Jointly Triage All Admissions
- Brief Interventions
- Inpatient Detoxifications Reduced 50%
- Saves Trust 1000 Bed Days (£300,000) Annually
- Rapid OPD – Sandra, Emma, C.A.T
- Assess Inpatients Daily Reduced Violent Incidents
JOINT GASTROENTEROLOGY/PSYCHIATRY NURSING
Weekly Clinic. Simultaneous with Doctors
Open Access – Phone, Secretaries, Ward
Regional Referrals
Improved Abstinence
Excellent Patient / Carer / Staff Satisfaction
Feedback Adaptation
Waiting Times, DNA Rates, Length of Stay
Network 50+ Link HCP’s
Education/Training/Support/Audit/Q.A
Data for Health Commissioners
District Health Promotion
2006 CLINICAL GOVERNANCE MEETINGS
Transparent, No-Blame Culture
All Deaths, Inquests
Clinical Incidents, Complaints
End of Life Care
Infections – MRSA, Cl. difficile– Root Cause
Analysis– 50% Reduction
Feedback – Trust Governance– Adaptation– Audit, Closing the Loop
SEAMLESS BOLTON DISTRICT ALCOHOL CARE
2007 UNIFIED PRIMARY, SECONDARY, C.A.T DETOXIFICATION- Lean Methodology, Saves Bed Days
2007/08 INTEGRATED BOLTON MULTIAGENCY ALCOHOL STRATEGY
2008 3 HEALTHCARE AWARDS - Access, Care, Overall Team Of The Year
2008 Pivotal Role with Public Health Team, Multiagency Partnership persuading
DH Team for Health Inequalities to make Bolton Early Implementer of National Alcohol Strategy
ALCOHOL-RELATED DISEASE
Meeting the challenge of improved quality of care and better use of resources
A Joint Position Paperon behalf of the
British Society of Gastroenterology,Alcohol Health Alliance UK and the
British Association for Study of the Liver
Key Recommendation (1)
A multidisciplinary “Alcohol Care Team,” led by a Consultant, with dedicated sessions, who will also collaborate with Public Health, Primary Care Trusts, patient groups and key stakeholders to develop and implement a district alcohol strategy.
DGH Requirement
Key Recommendation (2)
Coordinated policies on detection and management of alcohol-use disorders in Accident and Emergency departments and Acute Medical Units, with access to Brief Interventions and appropriate services within 24 hours of diagnosis.
DGH Requirement
Key Recommendation (3)
A 7-Day Alcohol Specialist Nurse Service and Alcohol Link Workers’ Network, consisting of a lead healthcare professional in every clinical area.
DGH Requirement
Key Recommendation (4)
Liaison and Addiction Psychiatrists, specialising in alcohol, with specific responsibility for screening for depression and other psychiatric disorders, to provide an integrated acute hospital service, via membership of the “Alcohol Care Team.”
DGH Requirement
Key Recommendation (5)
Establishment of a hospital-led, multi-agency Assertive Outreach Alcohol Service, including an emergency physician, acute physician, psychiatric crisis team member, alcohol specialist nurse, Drug and Alcohol Action Team member, hospital/community manager and Primary Care Trust Alcohol Commissioner, with links to local authority, social services and third sector agencies and charities.
DGH Requirement
Key Recommendation (6)
Multidisciplinary, person-centred care, which is holistic, timely, non-judgmental and responsive to the needs and views of patients and their families.
DGH Requirement
Key Recommendation (7)
Integrated Alcohol Treatment Pathways between primary and secondary care, with progressive movement towards management in primary care.
DGH Requirement
Key Recommendation (8)
Adequate provision of Consultants in gastroenterology and hepatology to deliver specialist care to patients with alcohol-related liver disease.
DGH Requirement
Key Recommendation (9)
National Indicators and Quality metrics, including alcohol-related admissions, readmissions and deaths, against which hospitals should be audited.
DGH Requirement
Key Recommendation (10)
Integrated Modular Training in alcohol and addiction, available for alcohol specialist nurses and trainees in gastroenterology and hepatology, acute medicine, accident and emergency medicine and psychiatry.
DGH Requirement
Key Recommendation (11)
Targeted funding for research into detection, prevention and treatment strategies and outcomes for people with alcohol-use disorders.
DGH Requirement
CONCLUSION
Many of these recommendations can be
implemented by intelligent re-organisation
and co-ordination of existing alcohol
services, while some require investment
in people.