COMMUNITY ALCOHOL DETOXIFICATION GUIDELINES NHFT DRUG & ALCOHOL SERVICES

Size: px
Start display at page:

Download "COMMUNITY ALCOHOL DETOXIFICATION GUIDELINES NHFT DRUG & ALCOHOL SERVICES"

Transcription

1 COMMUNITY ALCOHOL DETOXIFICATION GUIDELINES NHFT DRUG & ALCOHOL SERVICES NHFT Guidelines: MMG021 Date approved by Medicines Management Committee: May 2014 Review date: May 2016 Implementation date: August 2014 Director responsible for monitoring and reviewing policy: Medicines Management Committee Freedom of information category: Medicines Management Committee Dr Konstantinos Stagias, Consultant Authors: Psychiatrist Janice Jones, Pharmacist 1 of 20 Implementation Date: 01/08/14

2 TABLE OF CONTENTS 1. DOCUMENT CONTROL SUMMARY INTRODUCTION PURPOSE DEFINITIONS DUTIES The client Alcohol services staff are responsible for NHFT Prescribers General Practitioners GUIDELINES FOR A COMMUNITY ALCOHOL DETOXIFICATION Initial Assessment... 5 A specialist nurse shall undertake a comprehensive assessment of a client s suitability for community alcohol detoxification, including: Prior to detoxification Treatment Criteria for Community Alcohol Contra-indications (Not exhaustive) Procedure TRAINING Mandatory Training Specific Training not covered by Mandatory Training MONITORING COMPLIANCE WITH THIS DOCUMENT REFERENCES AND BIBLIOGRAPHY RELATED TRUST POLICY APPENDIX 1- MEDICATION CHART APPENDIX 2-ALCOHOL WITHDRAWAL ASSESSMENT SCORING GUIDELINES (CIWA AR) APPENDIX 3 - CONTRACT FOR ALCOHOL DETOXIFICATION PROGRAMME APPENDIX 4 ALCOHOL DETOXIFICATION FACT SHEET APPENDIX 5: NICE RECOMMENDATIONS FOR MANAGEMENT OF PATIENTS IN ACUTE UNPLANNED WITHDRAWAL of 20 Implementation Date: 01/08/14

3 1. DOCUMENT CONTROL SUMMARY Document Title Guidelines for Community Alcohol Treatment Document Purpose (executive brief) These guidelines provide NHFT staff with guidance on Community Alcohol Status: - New / Update/ Review Areas affected by the policy Policy originators/authors Consultation and Communication with Stakeholders including public and patient group involvement Review N/A Drug and Alcohol Services Dr Konstantinos Stagias, Consultant Psychiatrist, Substance Misuse Janice Jones Pharmacist Archiving Arrangements and register of documents Equality Analysis (including Mental Capacity Act 2007) Training Needs Analysis See section 7 Monitoring Compliance and See section 8 Effectiveness Meets national criteria with regard to NHSLA NICE NICE CG100/115 NSF Mental Health Act CQC Other Further comments to be considered at the time of ratification for this policy (i.e. national policy, commissioning requirements, legislation) If this policy requires Trust Board N/A ratification please provide specific details of requirements The Risk Management Team is responsible for the archiving of this policy and will hold archived copies on a central register See Control of Medicines Policy MMP001 3 of 20 Implementation Date: 01/08/14

4 2. INTRODUCTION refers to the planned medically assisted withdrawal from alcohol. Alcohol withdrawal carries risks (e.g. seizures and delirium tremens) and requires careful clinical management. NICE recommend that a medically assisted alcohol detoxification can be considered for a person who is drinking more than 15 units per day. It is also recommended that, following detoxification, abstinence is promoted. 3. PURPOSE The purpose of this guidance is to provide Alcohol Services clinical staff with clear guidance on management of medically assisted alcohol detoxification in a community setting. These guidelines should be used alongside the document MMG013 (Inpatient alcohol detoxification - May2014). 4. DEFINITIONS AUDIT - Alcohol Use Disorder Identification Test DoH - Department of Health NHFT - Northamptonshire Healthcare Foundation Trust NICE - National Institute for Health and Clinical Excellence NTA - National Treatment Agency CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol- revised edition 5. DUTIES 5.1. The client Is responsible for ensuring that they attend /are available for all planned appointments as failure to do so will result in the review of their treatment in line with the mutually agreed treatment contract Alcohol services staff are responsible for 1. Carrying out a comprehensive assessment, to establish if an alcohol detoxification is required and to complete all required documentation, including risk assessment and gaining consent, in line with NHFT policies. 2. Providing pre-detoxification support and information, liaise with all professionals involved and establish if the client has a GP. 3. Referring for an inpatient alcohol detoxification when necessary. 4. Undertaking baseline observations and monitor alcohol withdrawal symptoms daily during the home detoxification 4 of 20 Implementation Date: 01/08/14

5 5. Adjusting medication in line with assessment outcomes. 6. Referring to other specialist services as required following detoxification NHFT Prescribers Are responsible for reviewing the client, to identify any medical issues of note (in collaboration with the GP) and to initiate treatment and evaluate the effectiveness of the treatment. The NHFT prescriber will prescribe relapse prevention medication if required during and /or following the detoxification General Practitioners Are responsible for providing a medical history prior to commencing a home detoxification and to continue providing all normal GP health interventions. 6. GUIDELINES FOR A COMMUNITY ALCOHOL DETOXIFICATION Alcohol detoxification is a Tier 3 treatment. Once the service has received a referral, an assessment appointment will be offered Initial Assessment A specialist nurse shall undertake a comprehensive assessment of a client s suitability for community alcohol detoxification, including: 1. Assessment of the severity of alcohol dependence 2. Previous history of alcohol/drug problems 3. Previous treatments for alcohol use and experiences/outcomes. 4. Any history of fits, blackouts, hallucinations 5. Mental Health past and present mental health problems 6. Medical history - past and present physical health problems 7. Prescribed/Over the Counter medication and any sensitivities and/or allergies. 8. Blood investigations for Liver Function and Full Blood Count 9. Client s motivation/goals 10. Risk assessment. Assessment will also include the client s social situation and support networks to ensure that community detoxification is appropriate. A community detoxification is not an emergency intervention. 5 of 20 Implementation Date: 01/08/14

6 6.2. Prior to detoxification The following should be carried out before commencing a detoxification - - An initial home visit will be carried out prior to commencing the detoxification to ensure that the home environment is suitable. - The client should have adequate support throughout their detoxification due to the risk of severe withdrawal symptoms. - The client s General Practitioner (GP) should be approached to discuss whether there are any medical conditions which may make it unsuitable to carry out a community detoxification. - The GP could also be asked in writing whether they are willing to prescribe medication for detoxification and take medical responsibility. The GP may wish to see the client prior to detoxification. - Recent blood investigations including as a minimum Liver Function Tests and a Full Blood Count (see MMG 013) should be available and discussed with an NHFT doctor (and GP if required). - Baseline Blood pressure and Pulse should be recorded. - Drug sensitivities / history of allergies to be requested by the patient and their GP. - Community detoxification Care plan to be finalized, with contingency planning for emergency medical care and arrangements for unsuccessful treatment due to relapse in alcohol use. The client should be encouraged to plan for their community detoxification and their future aims and goals. Aftercare arrangements, including possible use of medication to support relapse prevention should also take place Treatment Chlordiazepoxide is the drug of choice for community detoxification. It is licensed in the United Kingdom for the management of acute alcohol withdrawal. It is used for initial stabilization following cessation of alcohol in order to prevent seizures and minimize other symptoms of physical withdrawal. The regime used will be based on the client s level of dependency. A tapering dose is recommended with the initial dose not expected to be exceeding 120mg daily. Do not offer clomethiazole because of the risk of overdose and misuse. Thiamine supplementation is recommended and there is extensive advice in the document MMG 013. Thiamine 100 mg three times daily and Vitamin B Compound strong 2 tablets three times daily should be prescribed as a minimum. Any conditions that would warrant treatment with parenteral Pabrinex, would commonly be a contraindication for a community detoxification (see MMG 013). 6 of 20 Implementation Date: 01/08/14

7 The following are for guidance and may be negotiated according to clinical/team judgement. 1. Clear information (Appendix 4) will be given to the client prior to treatment including the dependency potential of Chlordiazepoxide. 2. Treatment will be subject to a contract (Appendix 3) between the client and treatment service. The client signing the contract will indicate informed consent. 3. Chlordiazepoxide will be prescribed, at an initial dose of not more than 200mg daily. Chlordiazepoxide is available as 5mg or 10mg capsules, which are taken orally. In preference, 10mg capsules will be used. 4. Following commencement of treatment, the recommended reduction of dosage is at no more than 10-20mg per day over a period of 5-10 days, depending on clinical response. As part of the treatment programme the medication will be safely stored by the individual supporting the client (family or carer) and the dose advised by the NHFT nurse on a daily basis Criteria for Community Alcohol A diagnosis of dependence, as per ICD 10, is warranted when three or more of the following have been present together at some time during the previous year: a strong desire or sense of compulsion to take the substance difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use a physiological withdrawal state evidence of tolerance progressive neglect of alternative pleasures or interests persistence in use despite clear evidence of harmful consequences Narrowing of the personal repertoire of patterns of psychoactive substance use is also a characteristic feature. Rapid reinstatement, salience, relief drinking (Edwards and Gross) as well as unsuccessful attempts to quit (DSM-IV) are also frequently encountered. Clients identified as alcohol dependent and wishing to have an alcohol detoxification will be assessed. They should be drinking at least 15 units daily and / or score more than 20 on the AUDIT before they are considered for a community-based assisted withdrawal. This can be undertaken under primary care or in specialist alcohol services if there are safety concerns about a community-based assisted withdrawal. Not all clients will require medication to detoxify. Some clients can achieve this by gradually cutting down on the number of units consumed. A community setting for assisted withdrawal is as clinically effective and safe for the majority of patients as an inpatient or residential setting and it is also likely to be more cost effective. The programme can vary in intensity according to the severity of the dependence, available social support and comorbidities. NICE guidance recommends that contact between staff and the service user should average 2 4 meetings per week over the first week and on top of medication should incorporate psychosocial support including motivational interviewing. 7 of 20 Implementation Date: 01/08/14

8 A fixed-dose medication regimen is preferred and the service user should be monitored every other day. A family member or carer should oversee the administration of medication. The dose should be adjusted if severe withdrawal symptoms or oversedation occur. The service should avoid giving people large quantities of medication to take home to prevent overdose or diversion 6.5. Contra-indications for Community Alcohol (Not exhaustive) As per NICE, inpatient or residential assisted withdrawal should be considered if a service user meets one or more of the following criteria. They: drink over 30 units of alcohol per day have a score of more than 30 on the SADQ have a history of epilepsy, or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes need concurrent withdrawal from alcohol and benzodiazepines regularly drink between 15 and 20 units of alcohol per day and have: significant psychiatric or physical comorbidities (for example, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease) or a significant learning disability or cognitive impairment. A lower threshold for inpatient or residential assisted withdrawal should also be considered in vulnerable groups, for example, homeless and older people. Other conditions such as mental health problems (suicidal risk, personality disorders, confusional states due to Wernicke's or other memory impairment), physical health problems (malabsorption syndromes, decompensated liver disease, acquired head injury, dehydration, acute infection, fever), polypharmacy or polysubstance drug use or a history of previous unsuccessful home detoxifications may also be preferably managed in an inpatient setting. It is imperative that an adult (family member or friend) will be able to supervise the patient during the community detoxification and lack of such support may make necessary an inpatient alcohol detoxification If the client does not meet the criteria for a community detoxification then alternative treatment options will be explored such as a referral for an inpatient detoxification. It is envisaged that on occasions there will be situations where a decision has to be made on a balance of risk. Any decision that carries significant risk must be agreed between all the involved parties and relevant risk documentation must be completed. In the event that it may be inappropriate to manage a client s alcohol withdrawal with medication, then this can be facilitated by supporting and advising the client in safely reducing their alcohol intake over a period of days or weeks. 8 of 20 Implementation Date: 01/08/14

9 6.6. Procedure A Registered Nurse employed by NHFT who is specialised in the field of alcohol work would carry out community alcohol detoxifications in conjunction with the client s GP or NHFT doctor. Following assessment the client and/or their family/carer/support network will be given information (appendices 3 & 4) on the regime of community detoxification and the medication used for the community detoxification. Withdrawal symptoms will be explained and advice will be given regarding diet/fluid intake and rest. Information will also include NHFT and General Practitioner s telephone numbers in case any problems occur. The client and/or their family/carer/support network should ensure these are kept in a readily accessible place. A community detoxification care plan will be completed and the client will also sign a treatment contract for the community detoxification (appendix 3). Wherever possible, the detoxification should commence on a Monday thereby allowing 5 working days for establishing/monitoring outcomes. The NHFT Nurse will visit on a daily basis to monitor withdrawal symptoms, check blood pressure and pulse, take alcohol reading and titrate medication and offer support. The prescribing doctor will issue a prescription for chlordiazepoxide. The prescription will be collected from a community pharmacy, by the responsible adult who will ensure safe storage. As part of the treatment programme the individual will be given required medication on a daily basis by the responsible adult. The client also will be given written information on chlordiazepoxide, its risks and benefits. During the detoxification the following should be noted; - Clients undergoing a detoxification require plenty of fluids and are encouraged to attend to their dietary intake. If there is loss of appetite, the client should be encouraged to eat small amounts regularly. - If clients are unable to manage a meal, to encourage the client to drink sugary fluids to reduce the risk of hypoglycaemia (low blood sugar). - Additional home visits may take place if required. - Report to prescriber if any concerns or difficulties arise as a result of the detoxification. - Liaise regularly with the clients psychosocial worker if allocated. Daily monitoring requirements during the detoxification include; - Alcometer reading. - Blood pressure and pulse - Alcohol Withdrawal scale (CIWA-Ar) - Titration of the prescribed medication 9 of 20 Implementation Date: 01/08/14

10 All observations will be documented accordingly during and following daily visits. Chlordiazepoxide will be given to the individual on a daily basis as advised by the NHFT nurse. The nurse will also supply documentation (Appendix 1) with detailed advice on the treatment regimen. Prior to commencing the detoxification, the client is likely to have a positive reading when breathalysed, Chlordiazepoxide may still be administered when there is a positive blood alcohol concentration (BAC) reading but there is no sign of heavy intoxication. Caution should be taken where the BAC reading is above 100mg/dl, in which case it may be appropriate to delay medication until later that day. If the breathalyser reading is positive at any time during the detoxification, it may be necessary to stop the detoxification. Alcohol withdrawals can present 6-24 hours after the last drink is consumed and can peak within hours. Alcohol withdrawal seizures may occur 12 to 48 hors postdrinking alcohol withdrawals delirium tremens 36 to 96 hours post-drinking (Yost 1996). Confusion, disorientation, hallucinations and other neurological signs and symptoms can occur during a detoxification as a result of several complications of alcohol dependence. The differential diagnosis includes: Severe alcohol intoxication. Delirium Tremens Alcohol withdrawal seizure Wernicke s - Korsakoff syndrome Hepatic encephalopathy Head injury Hypoglycemia Alcohol related psychosis All of these conditions are potential life-threatening, therefore should be treated as an emergency that will require immediate admission to hospital. No alcohol dependent client should be advised to stop drinking immediately due to the potentially life threatening complications of Delirium Tremens (DT s), Seizures and Wernicke s Korsakoff Syndrome. The client s GP will be informed of the detoxification progress/outcome and a recommendation will be made to repeat LFT s and FBC four to six weeks following completion of detoxification and to continue to prescribe Vitamin B Complex/Thiamine for a period of 3 months. The alcohol nurse will assist the client to access relapse prevention work where appropriate and will liaise with the clients psychosocial worker confirming aftercare arrangements. 10 of 20 Implementation Date: 01/08/14

11 Where appropriate, clients will be offered relapse prevention medication e.g. Acamprosate, Naltrexone or Disulfiram. If prescribed, the NHFT doctor will review the client after one month and notify the GP, requesting they take over prescribing. All stages of the detoxification treatment are documented in Carepath in line with NHFT policies. 7. TRAINING 7.1. Mandatory Training There is no mandatory training associated with this policy Specific Training not covered by Mandatory Training Ad hoc training sessions based on an individual s training needs as defined within their annual appraisal or job description. 8. MONITORING COMPLIANCE WITH THIS DOCUMENT The table below outlines the Trusts monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs. Aspect of compliance or effectiveness being monitored Duties Measurement of baseline observations Correct prescribing regime Method of monitoring Individual responsible for the monitoring Monitoring frequency To be addressed by the monitoring activities below. Patient records Patient records Alcohol detoxification nurse Alcohol detoxification nurse Quarterly Quarterly Group or committee who receive the findings or report Medicines Management Committee Medicines Management Committee Group or committee or individual responsible for completing any actions Bedford Drug and Alcohol Services Bedford Drug and Alcohol Services Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed. 9. REFERENCES AND BIBLIOGRAPHY Drug Misuse and Dependence UK Guidelines on Clinical Management (2007) British National Formulary (latest edition) 11 of 20 Implementation Date: 01/08/14

12 Manufacturers summary of product characteristics (SPC) David B Cooper (1996) Alcohol Home & Assessment. Radcliffe Medical Press Department of Health (2009) Local Routes: Guidance for developing alcohol treatment pathways. National Institute for Health and Care Excellence (June 2013) Alcohol-use disorder diagnosis and clinical management of alcohol-related physical complications CG100 National Institute for Health and Care Excellence (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence CG115 QuADS Quality in Alcohol and Drug Services (1998) Alcohol Concern. 10. RELATED TRUST POLICY a) MMG013-Guidelines for Inpatient Alcohol 12 of 20 Implementation Date: 01/08/14

13 APPENDIX 1- MEDICATION CHART Name.. Start Date.. Prescribing Doctor Nurse DATE TIME DOSAGE TICK WHEN TAKEN REMARKS (WITHDRAWAL SYMPTOMS/ SIDE EFFECTS/ REASON FOR DOSE CHANGE) 13 of 20 Implementation Date: 01/08/14

14 APPENDIX 2-ALCOHOL WITHDRAWAL ASSESSMENT SCORING GUIDELINES (CIWA AR) Nausea/Vomiting Rate on scale 0-7 Tremors have patient extend arms & spread fingers. Rate 0 - none on scale mild nausea with no vomiting 0 no tremor 2 1 not visible, but can be felt fingertip to fingertip Intermittent nausea moderate, with patient s arms extended Constant nausea, frequent dry heaves and 6 vomiting 7 severe, even w/arms not extended Anxiety - Rate on scale no anxiety, patient at ease 1 mildly anxious moderately anxious or guarded equivalent to acute panic states seen in severe delirium or acute schizophrenic reactions Paroxysmal Sweats Rate on Scale no sweats 1 barely perceptible sweating palms moist beads of sweat obvious on forehead drenching sweats Tactile Disturbances Ask have you experienced any itching, pins & needles sensation, burning or numbness, or a feeling of bugs crawling on or under your skin? 0 - none 1 very mild itching, pins & needles, burning, or numbness 2 mild itching, pins & needles, burning or numbness 3 moderate itching, pins & needles, burning or numbness 4 moderate hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations Agitation Rate on scale normal activity 1 somewhat normal activity moderately fidgety and restless paces back and forth, or constantly thrashes about Orientation and clouding of sensorium Ask: What day is this? Where are you? Who am I? Rate scale Oriented 1 Cannot do serial additions or uncertain about date 2 Disoriented to date by no more than 2 calendar days 3 Disoriented to date by more than 2 calendar days 4 Disoriented to place and/or person Auditory Disturbances Ask, Are you more aware of sounds around you? Are they harsh? Do they startle you? Do you hear anything that disturbs you or that you know isn t there? 0 not present 1 very mild harshness or ability to startle 2 mild harshness or ability to startle 3 moderate harshness or ability to startle 4 moderate hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations Visual disturbances Ask Does the light appear to be too bright? Is its colour different than normal? Does it hurt your eyes? Are you seeing anything that disturbs you or that you know isn t there? 0 not present 1 very mild sensitivity 2 mild sensitivity 3 moderate sensitivity 4 moderate hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations Headache Ask, Does your head feel different than usual? Does it feel like there is a band around your head? Do not rate dizziness or light-headedness. 0 not present 1 very mild 2 mild 3 moderate 4 moderately severe 5 severe 6 very severe 7 extremely severe 1. Assess and rate each of the 10 criteria of the CIWA scale. Each criterion is rated on a scale from 0 to 7, except for Orientation and clouding of sensorium which is rated on scale 0 4. Add up the scores for all ten criteria. This is the total CIWA-Ar score for the patient at that time. Prophylactic medication should be started for any patient with a total CIWA-Ar score of 15 or greater (ie. Start on withdrawal medication). If started on scheduled medication, additional PRN medication should be given for a total CIWA-Ar score of 15 or greater. 2. Document vitals and CIWA-Ar assessment on the Withdrawal Assessment Sheet. Document administration of PRN medications on the assessment sheet as well. 3. The CIWA-Ar scale is the most sensitive tool for assessment of the patient experiencing alcohol withdrawal. Nursing assessment is vitally important. Early intervention for CIWA-Ar score of 8 or greater provides the best means to prevent the progression of withdrawal. 14 of 20 Implementation Date: 01/08/14

15 Patient Details ALCOHOL WITHDRAWAL ASSESSMENT FLOWSHEET Assess and rate each of the following (CIWA-AR Scale): Nausea/vomiting (0-7) Tremors (0 7) Anxiety (0-7) Agitation (0 7) Paroxysmal Sweats (0 7) Orientation (0 4) Tactile Disturbances (0 7) Auditory Disturbances (0 7) Visual Disturbances (0 7) Headache (0 7) Total CIWA-Ar Score: Date Time Pulse RR O² BP Refer to reverse for detailed instructions in use of the CIWA-Ar scale PRN Med: Dose given (mg): Time of PRN medication administration: Route: Assessment of response (CIWA-Ar score minutes after medication administered) RN Initials Scale for Scoring: TotTotal Score = 0 9 absent or minimal withdrawal 10 19: mild to moderate withdrawal More than 20: severe withdrawal Indications for PRN medication: a. Total CIWA-AR score 8 or higher if not started on regime b. Total CIWA-AR score 15 or higher if on Scheduled medication. (Scheduled +prn method) Transfer to A&E for any of the following: Total score above 35 or respiratory distress. SIGNATURE/ TITLE INITIALS SIGNATURE/TITLE INITIALS 15 of 20 Implementation Date: 01/08/14

16 APPENDIX 3 CONTRACT FOR ALCOHOL DETOXIFICATION PROGRAMME CONTRACT FOR ALCOHOL DETOXIFICATION PROGRAMME CLIENT.. PRESCRIBING DOCTOR.. NURSE. I have been given the treatment information leaflet and have had the opportunity to read it. I understand the implications, the benefits and risks of this treatment. My treatment plan is: DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 FIRST THING 12 NOON 6 PM BEDTIME This schedule may be changed by the nurse following assessment 1) My General Practitioner will be informed that I am on this programme and will be sent a copy of this contract. 2) I understand that any other use of drugs or excessive alcohol use must be discussed with my key worker. 3) I will take my medication as directed and as agreed in the treatment plan. 4) I will give specimens for testing when asked to do so. If alcohol is detected, my prescription may be stopped in accordance with the treatment plan. 5) I understand that my medication will not be replaced for any reason. 6) I understand that my medication is for my use only and no one else must use it. If I break this rule I know my prescription may be stopped. 16 of 20 Implementation Date: 01/08/14

17 7) I understand that failure to /be available for my medication on two consecutive days will lead to my prescription being stopped. 8) I understand that any attempts to obtain medication by deception, including approaching other doctors or altering prescriptions, will result in my prescription being stopped. 9) I understand that any verbal or physical aggression towards any member of staff, including pharmacy staff, will result in my prescription being stopped. I have read and understand this contract and agree to its terms Signed. Client. Nurse Date RELATIVE / SIGNIFICANT OTHER Please sign below if you agree to the following conditions of this home detoxification. Clients name: Relationship to client:. That you have read and understood the information about Alcohol withdrawal. That you are willing to take responsibility for the medication prescribed. That you will keep daily records of medication. Should any drinking take place, you will inform the Doctor or Nurse. Signed:.. Date:.. 17 of 20 Implementation Date: 01/08/14

18 APPENDIX 4 ALCOHOL DETOXIFICATION FACT SHEET Contact Details Hub:... Address:... Telephone Number:... Your Nurse is Based at.. Phone.. Follow Up Completing the detoxification is the first part of your recovery staying off is the next one. Who is providing your aftercare? Next appointment Date.. Time. Venue FACT SHEET Work YOU WILL NEED TO ORGANISE SOME TIME OFF WORK FOR AT LEAST A WEEK, TWO IF POSSIBLE. YOU CAN SELF-CERTIFICATE OR SEE YOUR DOCTOR FOR A SICK CERTIFICATE. Safety WHILST UNDERGOING THE DETOXIFICATION DO NOT: DRIVE OPERATE MACHINERY GO SWIMMING You may feel drowsy and shaky so you should be careful around the house. If possible, smoking and bathing should be supervised. It is advisable that partners/friends make hot drinks if possible to avoid burns, especially during the first part of your programme. Environment It is important for your home environment to be as quiet as possible and that you avoid bright lights. Try to make your surroundings as comfortable as possible. Sometimes you may feel irritable or anxious whilst undergoing the detoxification so these points may help you to relax more Diet Your appetite may be poor for the first few days. It is important to drink plenty of fluids as you may become dehydrated. Avoid pure orange juice as this may irritate your stomach water and milk are the most suitable. When your appetite improves try to eat small, light meals on a regular basis. 18 of 20 Implementation Date: 01/08/14

19 Physical You may experience vomiting, shakes, tremors or sweats. These symptoms may be more prominent in the first three days. If you are constantly being sick contact your keyworker or GP. Psychological/Emotional You may feel irritable or anxious during the detoxification period. You may also feel confused but this will pass. Your sleep pattern may be disturbed; try to rest and avoid sleeping during the day. Also avoid drinking tea or coffee (ie caffeine drinks) before you go to bed. Medication It is important that you take your medication as prescribed/ advised this will be closely monitored. Storing your Medication Your keyworker/carer will give you your medication each day. It is essential to remember that this medication is for your use only and can potentially be dangerous to others; therefore it is important that you ensure your medication is: Withdrawal Fits Research suggests that these fits may happen up to ten days after detoxification but this is quite rare. You may suddenly fall to the floor and your body may jerk/shake in the legs/torso region. If this does happen it can obviously be quite frightening for family/partners to witness and they need to be aware what to do:- a) Move any objects, furniture, etc that may injure the person out of the way; b) Loosen any tight clothing around the neck; c) If possible monitor how long the fit lasts; d) Telephone 999 for an ambulance; e) Once the fit has stopped, check the airway and place the person in the recovery position (see diagram below); f) When the person comes round they will feel confused and disorientated. This will pass although occasionally it may take a few hours; just make them as comfortable as possible and explain what has happened Kept in a high cupboard Not kept it in the fridge Kept away from children A free lockable box can be provided during treatment if required 18 of 20 Implementation Date: 01/08/14

20 APPENDIX 5: NICE RECOMMENDATIONS FOR MANAGEMENT OF PATIENTS IN ACUTE UNPLANNED WITHDRAWAL 20 of 20 Implementation Date: 01/08/14

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

REFERENCE. Admit to: Program/Service: Diagnosis: Droplet/ Contact Airborne/ Contact

REFERENCE. Admit to: Program/Service: Diagnosis: Droplet/ Contact Airborne/ Contact Weight (kg) REFER TO THE ALLERGY SCREEN IN MEDITECH FOR ALLERGY INFORMATION To complete the order form, fill in the required blanks and/or check the appropriate boxes. To delete orders, draw one line through

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for

More information

Assessment and management of alcohol dependence and withdrawal in the acute hospital

Assessment and management of alcohol dependence and withdrawal in the acute hospital Assessment and management of alcohol dependence and withdrawal in the acute hospital Concise guidance to good practice series June 01 CONCISE GUIDANCE Clinical Medicine 01, Vol 1, No : 71 Assessment Main

More information

Coping With Alcohol Withdrawal

Coping With Alcohol Withdrawal Coping With Alcohol Withdrawal Central and North West London NHS Foundation Trust Addictions Services Alcohol withdrawal When a person is dependent on alcohol and suddenly stops drinking there are certain

More information

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal February 2010 NICE clinical guidelines 100 and 115 1 These sample chlordiazepoxide dosing regimens

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Supported Alcohol Withdrawal Treatment Information

Supported Alcohol Withdrawal Treatment Information Supported Alcohol Withdrawal Treatment Information Alcohol Liaison Service What is Alcohol Withdrawal Syndrome? If you are dependent on alcohol and suddenly stop drinking or you are admitted to hospital

More information

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings Title: Identifier: Replaces: Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings NHSG/Guid/Detox_ADP/MGPG663 N/A - New document Across NHS Boards Organisation

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE Dr Millicent Chikoore MBBS MRCPsych Dr O Lagundoye MBBS MRCPsych Community based alcohol detoxification is a safe and effective option for

More information

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Issued: February 2011 guidance.nice.org.uk/cg115 NICE has accredited the process used by the Centre

More information

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety Alcohol Withdrawal Recognition and Assessment Alcohol withdrawal may be a presenting feature or occur as an unexplained development in a patient who has been admitted for other reasons and deprived of

More information

Alcohol Liaison Service. Alcohol Withdrawal. Information

Alcohol Liaison Service. Alcohol Withdrawal. Information Alcohol Liaison Service Alcohol Withdrawal Information Alcohol withdrawal If you are dependent on alcohol and suddenly stop drinking, there are a series of symptoms that you may experience. These include:

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within

More information

Alcohol-use disorders

Alcohol-use disorders Issue date: February 2011 Alcohol-use disorders Diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol dependence: NICE guideline FINAL DRAFT (February 2011) 1 NICE clinical

More information

Alcohol-use disorders

Alcohol-use disorders Issue date: February 2011 Alcohol-use disorders Diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol dependence: NICE guideline FINAL DRAFT (February 2011) 1 NICE clinical

More information

Management of benzodiazepine misuse

Management of benzodiazepine misuse York Service Management of benzodiazepine misuse Version 2 JT July 2013 page 1 background Note: not all those who use benzodiazepines are dependent, and not all those who are dependent will benefit from

More information

Assisted alcohol withdrawal

Assisted alcohol withdrawal A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online. This pdf

More information

Managing Patients with Alcohol Withdrawal

Managing Patients with Alcohol Withdrawal Managing Patients with Alcohol Withdrawal Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) Department of Medicine Regulated Health Professionals Developed by: Tammy Datars/Crystal

More information

Alcohol Dependence and Motivational Interviewing

Alcohol Dependence and Motivational Interviewing Alcohol Dependence and Motivational Interviewing Assessment of Alcohol Misuse Checklist Establish rapport patients are often resistant Longitudinal history of alcohol use Assess additional drug use Establish

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Medically assisted withdrawal from alcohol at home: A guide for you and your carer. Patient information leaflet

Medically assisted withdrawal from alcohol at home: A guide for you and your carer. Patient information leaflet Medically assisted withdrawal from alcohol at home: A guide for you and your carer Patient information leaflet What is medically assisted withdrawal from alcohol, and what is involved? For some people

More information

2.6.4 Medication for withdrawal syndrome

2.6.4 Medication for withdrawal syndrome .6.3 Self-medication Self-medication presents a risk during alcohol withdrawal, particularly when there is minimal supervision (low level and medium level 1 settings). Inform patients of the risk of selfmedication

More information

Alcohol. Problems with drinking alcohol

Alcohol. Problems with drinking alcohol Alcohol Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol. If you are alcohol- dependent then

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean 'alcohol dependence' (alcohol addiction). Some people are 'problem drinkers' without being dependent on alcohol.

More information

Memantine (Ebixa) Drug treatment for Alzheimer s disease

Memantine (Ebixa) Drug treatment for Alzheimer s disease IS 20 October 2011 Information sheet Memantine (Ebixa) Drug treatment for Alzheimer s disease Introduction... 1 How does Ebixa work?... 1 Who might benefit?... 2 What effect might Ebixa have?... 2 How

More information

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES 01736 850006 www.bosencefarm.co.uk DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES An environment for change Boswyns provides medically-led drug and alcohol assessment, detoxification and stabilisation.

More information

Alcohol detoxification

Alcohol detoxification Alcohol detoxification A guide to alcohol detoxification for service users and families. Stockton Treatment Alcohol and Recovery Service Alcohol dependence If you are dependent on alcohol then you will

More information

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.

More information

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Version 4 JT January 2014 page 1 Alcohol Management York Service assessment of alcohol

More information

A Guide to Alcoholism and Problem Drinking

A Guide to Alcoholism and Problem Drinking A Guide to Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

Alcohol Withdrawal Syndrome & CIWA Assessment

Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body.

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body. Alcohol information Facts about alcohol use Alcohol (grog) is the most widely used recreational drug in Australia NT drinks 70% more and WA 25% more than the rest of Australia Alcohol related deaths for

More information

GP Drug & Alcohol Supplement No.7 May 1997

GP Drug & Alcohol Supplement No.7 May 1997 GP Drug & Alcohol Supplement No.7 May 1997 This is the seventh of the monthly Drug and Alcohol Supplements prepared for Central Coast GPs. Detoxification from Alcohol Dr Tony Gill Introduction The management

More information

Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community

Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community Pharmacological Management of Acute Alcohol Withdrawal and Relapse Prevention in alcohol Use disorders in the Community Policy Descriptor This policy sets out the standards and procedures that all staff

More information

Maintenance of abstinence in alcohol dependence

Maintenance of abstinence in alcohol dependence Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE

CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE Unique Identifier Number: Approved By: NYA Effective From July 2010 Review Date: July 2012 Review

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

Alcohol-use disorders

Alcohol-use disorders Issue date: February 2011 Alcohol-use disorders Diagnosis, assessment and management of harmful drinking and alcohol dependence Developed by the National Collaborating Centre for Mental Health About this

More information

Prescribing for substance misuse: alcohol detoxification

Prescribing for substance misuse: alcohol detoxification Prescribing for substance misuse: alcohol detoxification POMH-UK Quality Improvement Programme. Topic 14a: baseline Prepared by the Prescribing Observatory for Mental Health-UK for Kent and Medway NHS

More information

How To Detox At Respite House

How To Detox At Respite House Respite House Alcohol Detox Client Information Sheet Cambridgeshire Community Services NHS Trust: delivering excellence in drug services across Luton as part of the ResoLUTiONs Pathway Respite House client

More information

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance Alcohol-use disorders: alcohol dependence Costing report Implementing NICE guidance February 2011 (February 2011) 1 of 37 NICE clinical guideline 115 This costing report accompanies the clinical guideline:

More information

Acute alcohol withdrawal

Acute alcohol withdrawal A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online. This pdf

More information

Donepezil hydrochloride (Aricept) Drug treatment for Alzheimer s disease

Donepezil hydrochloride (Aricept) Drug treatment for Alzheimer s disease IS 11 October 2011 Information sheet Donepezil hydrochloride (Aricept) Drug treatment for Alzheimer s disease Introduction... 1 How does Aricept work?... 1 Who might benefit from Aricept?... 2 What effect

More information

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care Hull & East Riding Prescribing Committee Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care 1. BACKGROUND Patients who are physically dependent

More information

Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol

Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol Context Detoxification or withdrawal is a key stage in achieving abstinence for people who are dependent on drugs

More information

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services SUBSTANCE DEPENDENCY For full details of the of the medication discussed in this formulary including side effects,

More information

INTOXICATED PATIENTS AND DETOXIFICATION

INTOXICATED PATIENTS AND DETOXIFICATION VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions

More information

BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM

BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM CRI Barking & Dagenham Community Alcohol Service St Luke s Centre Dagenham Road Dagenham RM10 7UP Tel 0208 595 1375 Fax 0208 595 1445 BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM ALCOHOL DETOXIFICATION ON

More information

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Medical assessment of patient with Alcohol Use Disorder Identification patients suitable for home detox Process for referral to inpatient

More information

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE 1 P a g e The following Operational Guidance Manual has been prepared with input from both community and prison addictions specialists

More information

Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra)

Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra) 1 Live Person Simulation Scenario Psychiatric and Mental Health Nursing (Sandra) I. Scenario Title: Assessment Interview & Medication Administration for a Client with Clinical Depression & Alcohol Abuse

More information

Galantamine hydrobromide (Reminyl) Drug treatment for Alzheimer s disease

Galantamine hydrobromide (Reminyl) Drug treatment for Alzheimer s disease IS 17 October 2011 Information sheet Galantamine hydrobromide (Reminyl) Drug treatment for Alzheimer s disease Introduction... 1 How does Reminyl work?... 1 Who might benefit?... 2 What effect might Reminyl

More information

Chapter 7. Screening and Assessment

Chapter 7. Screening and Assessment Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions

More information

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS Version: 3 Ratified by: Date ratified: November 2015 Title of originator/author: Title of responsible committee/individual: Senior Managers Operational

More information

MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS

MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS MANAGEMENT OF ALCOHOL PROBLEMS ON PSYCHIATRIC WARDS This guideline is primarily intended to assist in the medical management of alcohol dependent patients admitted to psychiatric inpatient units. For a

More information

1. According to recent US national estimates, which of the following substances is associated

1. According to recent US national estimates, which of the following substances is associated 1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Phenobarbital in Severe Alcohol Withdrawal Syndrome Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Disclosure: No relevant financial relationship exists. Objectives 1. Describe the pathophysiology

More information

YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines

YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines YCN Head & Neck NSSG Alcohol Assessment and Detoxification Management Guidelines *** VALID ON DATE OF PRINTING ONLY - all guidelines available at http://www.ycn.nhs.uk/ *** page 1 of 18 i Document Control

More information

OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE

OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE Introduction Admissions to hospital for alcohol detoxification in Skye and Lochalsh have been up to 78% higher than national average (www.scotpho.org))

More information

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS

ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS ALCOHOL ASSESSMENT AND DETOXIFICATION POLICY FOR INPATIENTS Version: 2 Ratified by: Date ratified: April 2015 Title of originator/author: Title of responsible committee/individual: Date issued: April 2015

More information

3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34%

3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% THCAT 3 rd most deprived area Registered population 240,000 Young population Growth of 30,000 in next 5 years Highest increase will be in working age 34% Bangladeshi (much higher in under 20s) Recent data

More information

Alcohol Dependence Inpatient management of Alcohol Withdrawal

Alcohol Dependence Inpatient management of Alcohol Withdrawal NHS Fife Community Health Partnerships Addiction Services Alcohol Dependence Inpatient management of Alcohol Withdrawal Intranet Procedure No A9 Author Dr. A. Baldacchino Copy No Lead Clinician Implementation

More information

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations

More information

Treating harmful drinking and alcohol dependence

Treating harmful drinking and alcohol dependence Understanding NICE guidance Information for people who use NHS services Treating harmful drinking and alcohol dependence NICE clinical guidelines advise the NHS on caring for people with specific conditions

More information

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4 Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) This document seeks to name the criteria that can guide referrals to residential tier 4 facilities (Part A). It provides guidance

More information

Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa )

Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa ) Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa ) ESCA: For the treatment of Alzheimer s disease. SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR

More information

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. Title: Staff Guidelines For The Management Of Alcohol Withdrawal In NHS Grampian Adult ( Age 18) Inpatients Unique Identifier: Replaces: (provided by the NHS Grampian Review Group for Clinical Process

More information

How To Know If You Should Be Treated

How To Know If You Should Be Treated Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors

More information

Residential Sub-Acute Detoxification Guidelines

Residential Sub-Acute Detoxification Guidelines I. Background Information A. Definition of Detoxification Residential Sub-Acute Detoxification Guidelines SAMSA s TIP #45, Detoxification and Substance Abuse Treatment: Treatment Improvement Protocols

More information

Alcohol Withdrawal Recognition and Treatment

Alcohol Withdrawal Recognition and Treatment Alcohol Withdrawal Recognition and Treatment Thomas Meyer BS EMS, MICP SREMSC Page 1 Purpose As EMTs a mantle of responsibility is placed upon you to ensure the safety and well-being of those in your charge

More information

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary

Alcohol Withdrawal in the AMU. Dr Ewan Forrest Glasgow Royal Infirmary Alcohol Withdrawal in the AMU Dr Ewan Forrest Glasgow Royal Infirmary The Society for Acute Medicine, 7 th International Conference, 3-4 October 2013 AWS: The Scale of the Problem Hospital Admissions (England):

More information

Interventions for harmful drinking and alcohol dependence

Interventions for harmful drinking and alcohol dependence Interventions for harmful drinking and alcohol dependence A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways

More information

Title Alcohol Withdrawal Management Guidelines

Title Alcohol Withdrawal Management Guidelines Document Control Title Alcohol Withdrawal Management Guidelines Author Consultant Physicians, Core Medical Trainee and Glossop Ward Manager Directorate Version Date Issued Status 0.1 Dec Draft Initial

More information

FACTS to know and QUESTIONS to ask

FACTS to know and QUESTIONS to ask FACTS to know and QUESTIONS to ask when applying for residential rehabilitation or inpatient treatment 01 Aftercare Learning new skills and coping mechanisms DETOX and REHAB Building motivation and setting

More information

Borderline personality disorder

Borderline personality disorder Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases

More information

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern

More information

Benzodiazepine & Z drugs withdrawal protocol

Benzodiazepine & Z drugs withdrawal protocol Benzodiazepine & Z drugs withdrawal protocol Rationale The NSF for Older People has highlighted the issues of dependence, sedation and fall in the elderly when taking these types of medications. It has

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK ACAMPROSATE CALCIUM (Campral EC) for alcohol abstinence ESCA: Adjunct in the treatment of chronic alcohol dependence (under

More information

Lewy body dementia Referral for a Diagnosis

Lewy body dementia Referral for a Diagnosis THE Lewy Body society The more people who know, the fewer people who suffer Lewy body dementia Referral for a Diagnosis Lewy Body Dementias REFERRAL FOR A DIAGNOSIS In the UK people with all forms of dementia

More information

Medication Guide KLONOPIN (KLON-oh-pin) (clonazepam) Tablets

Medication Guide KLONOPIN (KLON-oh-pin) (clonazepam) Tablets Medication Guide KLONOPIN (KLON-oh-pin) (clonazepam) Tablets Read this Medication Guide before you start taking KLONOPIN and each time you get a refill. There may be new information. This information does

More information

MEDICATION GUIDE WELLBUTRIN (WELL byu-trin) (bupropion hydrochloride) Tablets

MEDICATION GUIDE WELLBUTRIN (WELL byu-trin) (bupropion hydrochloride) Tablets MEDICATION GUIDE WELLBUTRIN (WELL byu-trin) (bupropion hydrochloride) Tablets Read this Medication Guide carefully before you start using WELLBUTRIN and each time you get a refill. There may be new information.

More information

General PROVIDER INITIALS: PHYSICIAN ORDERS

General PROVIDER INITIALS: PHYSICIAN ORDERS Height Weight Allergies If appropriate for patient condition, please consider the following order sets: Initiate Electrolyte Replcement: Med/Surg, Med/Surg Tele Physician Order #842 General Vital Signs

More information

Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults

Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* said you have alcohol use disorder

More information

How To Treat An Alcoholic Patient

How To Treat An Alcoholic Patient Height Weight Allergies If appropriate for patient condition, please consider the following order sets: Initiate Electrolyte Replcement: Med/Surg, Med/Surg Tele Physician Order #842 Discontinue all lorazepam

More information

75-09.1-08-02. Program criteria. A social detoxi cation program must provide:

75-09.1-08-02. Program criteria. A social detoxi cation program must provide: CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria

More information

University of Michigan Alcohol Withdrawal Guidelines Overview

University of Michigan Alcohol Withdrawal Guidelines Overview University of Michigan Alcohol Withdrawal Guidelines Overview The following document contains the University of Michigan Alcohol Withdrawal Guidelines. These guidelines were developed through an intensive

More information

VALIUM PRODUCT MONOGRAPH. diazepam. 5 mg Tablets. Anxiolytic-sedative. Date of Revision: February 7, 2014

VALIUM PRODUCT MONOGRAPH. diazepam. 5 mg Tablets. Anxiolytic-sedative. Date of Revision: February 7, 2014 PRODUCT MONOGRAPH VALIUM diazepam 5 mg Tablets Anxiolytic-sedative Hoffmann-La Roche Ltd. 7070 Mississauga Road Mississauga, Ontario L5N 5M8 Date of Revision: February 7, 2014 www.rochecanada.com Submission

More information

How To Stop Drinking

How To Stop Drinking Title Version 3.0 Nottinghamshire Primary Care Alcohol Misuse Guidelines Author / Nominated Lead Lead - Dr Stephen Willott, GP Windmill Practice, Nottingham; Clinical Lead for alcohol/drug misuse, NHS

More information

Prescribing Framework for Donepezil in the Treatment and Management of Dementia

Prescribing Framework for Donepezil in the Treatment and Management of Dementia Hull & East Riding Prescribing Committee Prescribing Framework for Donepezil in the Treatment and Management of Dementia Patients Name:.. NHS Number: Patients Address:... (Use addressograph sticker) GP

More information

Facts About Alcohol. Addiction Prevention & Treatment Services

Facts About Alcohol. Addiction Prevention & Treatment Services Facts About Alcohol Addiction Prevention & Treatment Services Table of Contents Facts about alcohol: What is harmful involvement with alcohol?... 2 What is alcohol dependence?... 3 What Is BAC?... 4 What

More information

Alcohol treatment Information for service users Page

Alcohol treatment Information for service users Page South London and Maudsley NHS Foundation Trust Alcohol treatment Information for service users Page This leaflet tells you what you can expect during treatment for problems related to using alcohol. It's

More information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

Symptom Based Alcohol Withdrawal Treatment

Symptom Based Alcohol Withdrawal Treatment Symptom Based Alcohol Withdrawal Treatment -Small Rural Hospital- Presenter CDR Dwight Humpherys, DO dwight.humpherys@ihs.gov Idaho State University Baccalaureate Nursing Program Lake Erie College of Osteopathic

More information