NHS LANARKSHIRE ACUTE DIVISION SUBSTANCE MISUSE NURSE LIAISON SERVICE ANNUAL REPORT

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1 NHS LANARKSHIRE ACUTE DIVISION SUBSTANCE MISUSE NURSE LIAISON SERVICE ANNUAL REPORT PI/Annual Report 2009/10 1

2 CONTENTS Executive summary Background Partnership Working Brief Interventions Performance Management & Variations of output/outcome Financial Summary Additional Information Conclusion PI/Annual Report 2009/10 2

3 EXECUTIVE SUMMARY The Substance Misuse Nurse Service of NHS Lanarkshire has been running successfully since The service continues to develop in response to Public Health initiatives and the needs of this specific patient group. Patients continue to be offered support within the hospital and via the support of the out patient clinic. This has had a positive effect on admission rates and planned discharges. The service also continues to act within its specialist capacity to develop staff and provide evidence based tools to improve intervention outcomes for this patient group. Funding continues to support 6 WTE band 6 staff with one member of the team currently acting as Band 7 team lead. This post is due for review in July Each site continues to have part-time administration support. Further work has been undertaken to develop pathways of care between key partner agencies. This was compounded by a development day and subsequent follow up review. Key areas of development have focussed on government lead targets relating to Alcohol Brief Intervention (HEAT 4) and the Decrease in Emergency Care Attendances (HEAT 10). The Substance Misuse Nurses follow the framework of NHS Lanarkshire Acute Division Alcohol Policy to support the delivery of HEAT 4 Alcohol Brief Interventions. The service continues to support the key themes set out by Lanarkshire Alcohol and Drug Partnership Throughout the last year the service has continued to develop and train staff in the detection of early alcohol misuse issues. To date 198 staff within emergency care have been trained in the use of FAST screening tool and the appropriate level of intervention. This will be an ongoing component of the service due to the rapid turnover of medical staff within Emergency Care. PI/Annual Report 2009/10 3

4 Additional funding supplemented and addressed workforce planning capacity issues in connection with this target. A clinical support worker was employed on a daily basis throughout February and March. The aim of this additional support was to increase screening output and raise the profile of the HEAT 4 target within emergency care. Information gathered clearly supports the positive impact of employment of additional staff to support this agenda. The FAST alcohol screening has been integrated into the revised Emergency Care Admission Document. It is envisaged that this will promote a positive effect on staff information gathering and early identification of alcohol related harm.. Key work has been carried out developing a new integrated care pathway for the management of alcohol withdrawal within the acute setting. Launch of this new pathway is imminent after completion of a successful pilot within acute areas of all 3 sites. BACKGROUND The Substance Misuse Nurse Service originated in 2002 and with the continued financial and strategic support from the ADP has evolved into a team of 6 WTE nurses with 3 part time admin support staff. One nurse is currently leading the service as an acting Band 7. The core aims of the service continues to focus on:- Continued promotion of good practice that is supported by evidence based interventions. Promotion of healthy lifestyle choices that improve health outcomes for the target patient group. Development and training of staff to support a care plan which incorporates individualised patient needs and adheres to Recovery Model. Promotion of equanimity of service across the 3 sites Profile raising of the specific needs of this patient group across NHS Lanarkshire acute care division. PI/Annual Report 2009/10 4

5 Monitoring and collation of information to identify and react to changes that influence public health agenda. Continue to link with wider health care services within primary care, voluntary and acute care based settings ensuring a seamless transfer of care for patients throughout their personal journey PARTNERSHIP WORKING The service continues to strive to maintain and improve good partnership working with key stakeholders within community based care settings. A successful development day was hosted by the service in October Representatives attended from services in both North and South Lanarkshire. The day was facilitated by the LEAN team of NHS Lanarkshire. Presentations were given from SMN service, LADDS and LEAN. Key focus of the day was to examine the patient journey and identify areas for improvement and avoidance of duplication within the system. Areas of further development were identified and positive outcomes that have been achieved include:- Telephone access to triage appointments direct from acute services have reduced waiting time between hospital and community Development of an ICP that has highlighted the need for the named worker to be informed of admission Joint development of PGDs that support detox of patients, both as clinic attendees to the acute sites and home based detoxes Greater understanding of other s role within service and the benefits of combined working relationships for the benefits of patients The development day was felt to be a great success and fostered an increased sense of partnership working between acute care and key health and social work services in both North and South Lanarkshire. PI/Annual Report 2009/10 5

6 BRIEF INTERVENTIONS The Scottish Government continue to incorporate A/E as a key screening target area for brief intervention within the HEAT 4 target. The SMN service have continued to support this delivery at all levels. In continuance with the key areas that were set out last year we are happy to report:- 1. Training All 6 members of staff have completed Health Scotland Training for Trainers course. Training of staff within emergency care has continued. One member of the team has contributed as a trainer to the recent Health Scotland A/E trainers update. Two members of the team were invited and participated as members in the Health Scotland HEAT 4 A/E sub group. At present 198 staff members have been trained in screening across all 3 acute sites. This is an ongoing process due to the rapid turnover of medical staff. 2. Patient Information Leaflets & Prompt Cards Have been developed and are now in place. Staff report that they are easy to use and helpful when carrying out screening. They have also been highlighted by Health Scotland as being an area of good practice and have been duplicated by other Health Board Areas. 3. Number of patients screened in A&E Alcohol screening within A/E continues to present workforce planning challenges. From July 2009 to December %- 0.32% of new attendances at A&E were screened. Lanarkshire ADP responded positively to this challenge and we were kindly provided a further 10,000 funding. This money was utilised to provide a CSW on each site for 8 hours a day. This was not only to improve screening numbers but also to raise the profile of the HEAT target within emergency care. The pilot ran throughout February and March 2010 and proved to be highly successful. Variations of screening rates throughout period are noted overleaf PI/Annual Report 2009/10 6

7 % of total A&E admissions screened for alcohol consumption 20% 18% 16% 14% 12% 10% 8% Hairmyres Monklands Wishaw NHSL 6% 4% 2% 0% Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar Brief interventions The SMN service continues to carry out brief interventions either within their out patient clinics or during in patient stay. In total 991 alcohol brief interventions have been carried out across the 3 sites. The substance misuse nurses continue to offer appointments for support to all individuals who screen as FAST 3+ within emergency care. However despite best efforts no returnees are recorded for ABI s referred following screening by emergency care. 5. Referral to support services Continues to be recorded via SMN data base that is monitored by the ADP The responsibility for implementation, monitoring, reporting and audit of the brief intervention agendas, will continue with the SMN service for their designated site, under the direction of the team lead and nurse consultant for emergency care. PI/Annual Report 2009/10 7

8 PERFORMANCE MANAGEMENT & VARIATION OF OUTPUTS/OUTCOMES The Substance Misuse Nurse Service continues to provide a valuable service to meet the needs of acute care services and the patients who access these services for treatment. The service continues to be managed by the nurse consultant for emergency care. A team lead has been established, with a member of the team presently acting as band 7. This has had a positive affect on:- Regular attendance at key strategic groups Division of roles, responsibilities and workload. Core training work being undertaken. Commencement of clinical supervision. Review of this temporary post is due to take place in July Previous vacancy issues have been resolved and the service has a full complement of staff. Waiting Times The service continues to operate within national target times of 14 days from referral to treatment. The service has no waiting time. In-patients are reviewed following admission and/or prior to discharge. Emergency room attendees are subject to the 4 hour operational target. Therefore 100% patients are seen within the national target times. Attendance rates for 2009/2010 Referrals to the service have decreased throughout this period patients were seen throughout 09/10. This represents a decrease 11.68% decrease overall. New Clients Total referrals Hairmyres Monklands Wishaw Total PI/Annual Report 2009/10 8

9 There would appear to be no reason for this as the service has not ran at a reduced rate throughout this period. Down time has therefore been utilised to take forward the work arising from the HEAT 4 Target. Referral source Speciality referred from Hairmyres Monklands Wishaw Total Medical A&E Surgical Psychiatry Null/Not recorded/ Unspecified Self Orthopaedic Addictions Infectious Diseases Gastroenterology Cardiology ERU Dermatology GP Inapplicable Renal Maxillofacial Geriatric ECU Social Work Obstetrics Haematology Urology Gynaecology The above table outlines the source of referral for all the substance misuse referrals within the acute division. It should be highlighted that there are variances between all 3 sites due to slight differences on all 3 databases. Variances of note include:- Psychiatric referrals are not on Hairmyres data set as a CRISIS team is in place Infectious Diseases is only based on Monklands site ERU numbers are likely to be included in A/E and Medical referral numbers There has been a significant decrease in self referrals at Monklands site due to work carried out since the development day PI/Annual Report 2009/10 9

10 Onward referrals Action/referral to: Hairmyres Monklands Wishaw Total LAADS NLIAS SW SMT Voluntary sector AA/CA/NA Detox Refused further intervention No FU required Other N.B. 1 client may have more than one option ticked. CISS The Christo Inventory Scoring system (CISS) is used for all patients who present to the emergency department services. The information collated in the table below shows the mean CISS scores for clients assessed in 2009/2010. Mean CISS Haimryres 12.4 Monklands 11.0 Wishaw 9.9 Harm Reduction The service continues to provide a range of interventions and harm reduction initiatives including: Needle exchange packs being available on each site with top-up from Harm Reduction team,coatbridge Needle exchange distribution 2009/2010 Site Yellow Red Green Pharmacy Hairmyres N/A Monklands Wishaw N/A PI/Annual Report 2009/10 10

11 Monklands have moved to a pharmacy pack provision due to volume of requests within department Introduction and implementation of near drug death presentations" to the ER being referred to SMN Service/Harm Reduction team. Opt-in letters are forwarded to the patient. Further work will be carried out in conjunction with harm reduction team throughout Advice and support re BBV with referral to BBV service in Monklands. Further areas of work have been identified in conjunction with and support from Trish Tougher (BBV Network Manager) Provide practical support measures to patients and families for harm reduction including advice re safer sex and reducing risk of sexually transmitted diseases. Provide support and advice to reduce problems related to alcohol and drug misuse giving a wide range of advice and information to patients and their families. Health Promotion The Substance Misuse nurses have continued to have various health promotion activities throughout the year including: Week long representation at front of hospital during alcohol awareness week Raising awareness of alcohol consumption in staff restaurant Contribution to Men s Health Week events within acute site hospitals. Hosted a festive health and safety event on behalf of SHAW group. The service were joined at these events by representatives from Fire, Police and Sexual Health Services PI/Annual Report 2009/10 11

12 FINANCIAL SUMMARY The table below outlines the budget position for YTD Budget YTD Actual YTD Variance Total Pays 266, ,682 4,443 Total Supplies 2,160 6,572 (4,412)* * The financial overspend on supplies can be directly attributed to the development and production of materials to support HEAT 4 Target. As a total overall % budget remains within allocation for year. Payment from Health Scotland for service contribution at recent training event has not been included but has been queried through Finance. OTHER INFORMATION/ACTIVITIES The nursing staff been released for a day on a twice yearly basis to attend a Substance Misuse Forum which has been found to be most positive for networking with other colleagues carrying out the same role within Scotland. Training of staff on the MINTS course continues. CHILD PROTECTION The needs of children who are being cared for by substance misusing parents remain high priority. Specific areas of development include:- The nurses have attended child protection study days and a further development afternoon has taken place to address specific needs of service. Support for this was provided by child protection team of NHSL A direct pathway has been developed to support the team with the gathering of information through established I.T. systems. PI/Annual Report 2009/10 12

13 Development of a protocol to meet the needs of intoxicated adolescents who attend A/E. This protocol has been ratified by the child protection steering group of NHSL. Work will be undertaken in conjunction with the child protection links on each 3 sites to promote this document within emergency care. CONCLUSION In conclusion the SMN service continues to provide a robust service across all 3 acute sites. They have risen to the challenge of Public Health demands which have demanded changes in service direction to include preventative and information based health promotion. They have also been directly involved in the profile raising and early identification of Anthrax within acute care and have ensured management of patient pathway into community based services. Key areas of development in the year ahead will include:- Increased partnership working between emergency care services and harm reduction team Completion of trialled assessment form and work to standardise data set Increased partnership working between service and BBV service to detect and refer at risk and diagnosed patients within our referral group. Continuance of focus on importance of alcohol screening and brief intervention within emergency care. Substance Misuse Team NHS Lanarkshire Gillian Corbett Nurse Consultant Emergency Care PI/Annual Report 2009/10 13

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