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Nursing Times Awards 2010

Accident and Emergency Nursing Award


WINNER: Caring for patients with drug, homelessness and safeguarding issues, Dave Roberts, Carol Holt, Clare Pritchard and Paul Thompson, Royal Liverpool and Broadgreen University Hospital Trust


People affected by and compromised by drug and substance misuse are among the most vulnerable members of society. The devastating consequences of involvement in this potentially life-threatening and dangerous activity are often observed first hand by front-line staff within our trust.

The dedication and hard work of A&E staff, who deal with upwards of 90,000 attendances a year, is unquestioned. However, there was evidence to suggest that vulnerable patients with homelessness, drug and safeguarding issues, such as sex workers, experienced gaps in their journey from attendance to discharge, with potentially hazardous consequences.

If the trust was to implement the recommendations of the National Institute for Health and Clinical Excellence guideline on reducing substance misuse among vulnerable young people, and to meet the requirements of the local primary care trust in offering best practice and holistic care to this group, a tailored service was essential. The four trust leads for adult and child safeguarding, homelessness, and substance misuse agreed jointly to set up a dedicated 24-hour a day, 365 days a year service to ensure the highest standards of care and a seamless delivery of both trust and external services.

Each of us delivers education and teaching to all members of the multidisciplinary team, with the aim of changing attitudes and ensuring our patients’ needs are recognised and enhanced. Consistent and thorough implementation of standardised education packages has raised awareness of these socially excluded patients and removed previous barriers to healthcare provision. We also established links with the local PCT and universities, and practice facilitators within the trust.

The process

We realised at an early stage that patients affected by these issues often had gaps in their journey of care because the chaotic lifestyles they led frequently barred them from accessing services both within the trust, and in the community. We rapidly expanded our capacity to educate, inform and advise not only staff, but also patients. Fundamentally , our aim was to educate, and to form strong links both internally and externally with all agencies and departments involved in care provision.

Advice to other organisations

We envisage that through consistent and proficient education, our teamworking approach can be adapted in any healthcare area, whether hospital, GP or other services.

We hope that by providing evidence of best practice, and the positive feedback we have received from various disciplines, we can enable nurses to reassess their “care ethic” and their ability to think laterally as well as constructively in questioning preconceived ideas about the difficulties associated with caring for patients affected by drugs, homelessness and safeguarding issues. A sustained and positive approach is essential to maintaining best practice for this patient group.

We help some of the most vulnerable and frightened patients admitted into the trust, and acknowledge that we must recognise our own limitations. Our team approach means we can turn to each other for support and advice. Those planning a similar initiative must be passionate about providing the highest standards of care. Patients whose lives are already compromised need non-judgemental, supportive, and empowering care.

Benefits of the initiative

Our patients are our first priority. We endeavour to treat them all with respect, and to give them access to services and care previously denied on both a practical and an emotional level. Through education we hope to remove the stigma often attached to these patients so they feel their care is as valid, viable, constructive and healing as any other patient.

We have received extremely positive patient feedback from questionnaires about the accessibility of our service, and firm acknowledgment from local and national legislative institutions. In addition, patient research by the PCT has received positive feedback demonstrating that patients now feel confident that they will receive full, holistic care if admitted to the trust.

Close links established with both John Moores and Liverpool universities mean all four of us regularly teach both nursing and medical students, and qualified nurses and doctors. We also teach a range of community agencies about substance misuse, such as Liverpool School for the Deaf, and we spoke at a conference on chronic obstructive pulmonary disease in 2009, discussing the increasing incidence of COPD among heroin smokers. Our safeguarding leads for adults and children present nationally and locally, while our homelessness lead also is actively involved in policy and procedure writing.

Financial implications

While it is difficult to quantify the cost implications or savings in relation to our work to date, we have not incurred any additional costs for education and teaching. For example, we regularly invite guest speakers who kindly waive any fees.


For more information on this initiative please contact Paul Thompson:


Readers' comments (2)

  • Well Done!!!

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  • Clinical excellence and professionalism at its very best. Couldn't these nurses advise on training of all adult nurses working with vulnerable patients, which should become statutory, and help erradicate stigmatism of vulnerable members of society, firstly amongst nurses, and then through them the general public to whom they should be setting an example.

    I find it hard to believe that there are so many diverse opinions and lack of understanding and care from nurses of patients with dependency and mental health problems and disorders when we are all supposed to be working together towards common goals. This may stem partly from ignorance and lack of education and training in this area which if we wish to carry out holistic care cannot be ignored.

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