A&E Scratchcard Pilot

Transcription

1 A&E Scratchcard Pilot 20 September 2012 Helen Clay Specialist Nurse, Alcohol

2 Purpose of Pilot Introduce alcohol AUDIT C screening in A&E Gain an improved understanding of alcohol use of those attending A&E To increase the number of brief interventions in A&E To increase alcohol awareness with staff and patients Patient criteria for taking part in pilot Attendance at A&E University Hospital of North Tees Stockton residents only Aged over 18 years Triage patients accessing A&E from 19 March 30 June

3 Implementation Agreed at Alcohol Secondary Care meeting as a positive initiative to trial Pilot discussed and approved by A&E Directorate meeting Importance of buy in via A&E Consultants, Senior Clinical Matron and A&E Reception Manager Formed Scratchcard working group Format of Scratchcard agreed Alcohol Nurse delivered six educational sessions in A&E Data Collection

4 Process Patient Information Notice displayed on reception advising that a project was being undertaken regarding alcohol consumption in Stockton residents Reception staff distributed cards to A&E patients Patient CRN number placed on scratch card by Reception Staff Card returned by patient to triage nurse Triage Nurse monitored scores, gave brief intervention for those scoring 5+ and patient information leaflet as required Audit scores recorded on A&E assessment record by triage Completed scratchcards placed in a secure box in triage room

5 What next? Completed scratch cards collected by the drug and alcohol referral team (DART) based in the University Hospital of North Tees Cards included a patient opt out clause for further information Anyone scoring over 9 on the scratch card assessment would be contacted by the drug and alcohol referral team. Scores of 5-9 were given brief interventions by A&E staff and a brief advise leaflet. Data from scratch cards entered into database for the pilot by DART - (no personal information included) Data analysed by Balance North East who paid for the whole pilot from the scratch cards, brief advise leaflets and data analysist.

6 Data Balance Analysis 848 scratch cards returned by patients 612 had all data fields fully completed 50 did not want information used for statistical purposes 798 useable records 46% were categorised as drinking at increasing or higher risk levels 55% of males were drinking at increasing or higher risk levels and 35% of females Highest % of cards (23%) collected from year olds 19% of patients aged 65+ were drinking at increasing or higher risk levels 32% scoring between 5-8 on Audit C refused further advice from the alcohol team and 36% of those scoring 9-12 on Audit C

7 Qualitative Analysis Focus Groups held Qualitative Analysis undertaken by Dr Simon Howard, Public Health Registrar Issues identified in Focus Groups Commitment of staff to the project throughout its life the number of scratch cards collected decreased significantly towards the end of the pilot Confidentiality and Data Sharing Time taken to print scratch cards delayed implementation; materials not available for training Shift pattern in A&E meant difficulties in accessing all staff for training

8 Issues continued Improved communication between parties was needed during the pilot i.e DART should have given weekly feedback to staff and statistics to jivvy things up (learning curve). The interest was there and it needed regular motivation. Ensure everyone is clear regarding tools to be used, eg, box to collect cards, use of PILS. At about week 2 a pathway was put in triage for staff to follow. Responding to patient queries, eg, why are you giving me this?the reception staff felt uncomfortable at times and gave the cards to those who they felt would not give them any grief. They did have a couple of incidents were patients were verbally aggressive. Capacity to widen scheme to non-stockton residents 848 scratch cards were completed out of a possible 9,000+ Stockton residents going through A&E during the pilot and number of completed cards returned. However this 9000 was not just triage patients and it did include 17 yr olds. Data retrieval issues time to input/missing data Feedback to staff in A&E on progress

9 Positive Outcomes Awareness raising of alcohol consumption of patients. Awareness raising of alcohol consumption of staff. Raised profile of alcohol issues in A&E. Some staff now voluntarily asking and recording unit intake. Overall scratch card considered to be a good idea by staff and positively received. Increased commitment in A&E to continue with identification in some form, implementation of Audit C lanyards carried by staff. Alcohol identified on assessments more often now.

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