Pat Elliott, RN, CertEd; Margaret Davies, RN, DipN; Elaine Scott, BA (Hons), RN, CertEd
Pat-Ward Manager; Margaret-Ward Manager; Elaine-Clinical Governance Co-ordinator, Medical Directorate, Arrowe Park Hospital, Wirral Hospital NHS TrustThe cost to the NHS of alcohol problems is phenomenal (see Boxes 1 and 2). In the Wirral, north-west England, a total of £1.3 million was spent on alcohol-related cases in 1998-1999 between secondary and primary care (Jones, 2001).
A core team of the two gastroenterology ward managers and the clinical governance co-ordinator carried out a three-month audit in 1998. They:
A multidisciplinary team was set up in 1999 to develop an alcohol care pathway to address the issues raised. The team comprised two ward managers, the clinical governance co-ordinator, three gastro-enterology consultants, the Wirral Alcohol Service manager, a local GP with an interest in alcohol misuse, a social worker, a pharmacist based on the gastroenterology wards, and a risk management member.
A series of workshops were held, with 30 nurses, pharmacists and specialist nurses at each, attending from all directorates in the trust. Four sessions were also held for junior doctors and consultants. The aim was to increase awareness of the new categories and how to deal with patients with alcohol-related problems. The importance of the new medication regimen and individualised care for patients were highlighted.
An alcohol liaison nurse post was created, funded from Health Action Zone money, in March 2000. The initial idea came from the medical directorate, supported by the clinical director. But the post was funded externally, working with the Wirral Alcohol Service, psychiatry and acute areas. The idea was for this nurse to see patients in the acute setting and for later support to be offered via Wirral Alcohol Service after discharge, due to time constraints facing the nurse.
Despite increased training, some medical and nursing staff resisted the change. A retrospective audit was carried out on patients admitted between October 2001 and February 2002 to determine if the alcohol care pathway had been used during admission.
We are aware of our clinical governance responsibilities, and in line with this, incidents involving patients with alcohol excess will be monitored. We are drawing up a plan to deal with recurring incidents by reporting them to the risk management department. This is in its early stages but forms part of our clinical governance agenda.
The care pathway has had a role in transcending primary and secondary care boundaries. It has involved a multidisciplinary team, and needs more development. The audit data indicated larger numbers of patients with a secondary diagnosis of alcohol misuse than previous figures had suggested.
Alcohol Concern. (2001) Alcohol and Mortality (Factsheet 18). London: Alcohol Concern. Available at www.alcoholconcern.org.uk
Alcohol Concern. (2002) Your Very Good Health. London: Alcohol Concern. Available at: www.alcoholconcern.org.uk
Godfrey, C., Maynard, A. A health strategy for alcohol: setting targets and choosing policies. York: Centre for Health Economics.
Hodson, R., Alywyn, T., John, B. et al. (1999) The Fast Assessment Screening Tool. Cardiff and London: University of Wales, College of Medicine and Middlesex University.
Jones, M. (2001) Appraisal of services provided to people who misuse alcohol in Wirral. Wirral: Wirral Drug Action Team on behalf of Wirral Health Authority.
Sullivan, J.T., Swift, R.M., Lewis, D.C. (1991) Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using standardised withdrawal scale. Journal of Clinical Psychopharmacology 11: 5, 291-295.