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)) due to a lack of alternatives Evidence from results of reviews by National Treatment Agency for Substance Misuse (NTA) and Sign on comparison of detoxification treatments for alcohol dependency found no difference in clinical outcomes between in-patient and out-patient detox. At least 75% of detoxes can be carried out in the community (SIGN,2003) Out-patient detox is cost-effective when compared to in-patient (NTA)

Proposal That a supervised out-patient alcohol detox clinic be set up in Broadford and Portree Hospital providing safe and effective withdrawal from alcohol utilizing individualized treatment plans

Objectives To enable patients to participate in outpatient detoxification To provide accessible, responsive service To provide alternative for medical staff and client to inpatient or home detox To provide daily nurse-led assessment and monitoring of withdrawal symptoms and mental/physical state To supply appropriate medication to alleviate symptoms of alcohol withdrawal in a safe and efficient way

To provide daily supervised supply of medication, thereby reducing risk of misuse, overdose or resale To reduce the number of admissions to hospital for inpatient detox To offer daily counselling/support whilst withdrawing from alcohol ol To encourage engagement with alcohol support services To provide appropriate educational support and information to patients

Referral Criteria Referrals to the service will be accepted from the following: GP s Rural Practitioners s Self

Inclusion Criteria Patient physically dependent on alcohol No major physical problem Is motivated to detox from alcohol Agreement to abstain from alcohol Agreement to adhere to conditions of OP Detox

Exclusion Criteria Patient intoxicated (should be asked to cease drinking and return later that day or next) Patient unable/unwilling to attend clinic daily

Exclusion Criteria Inpatient detox is advised if patient: Is confused or has hallucinations Has history of previous complicated withdrawal Has epilepsy or history of withdrawal seizures Has severe vomitting or diarrhoea Is at risk of suicide Has history of repeated failed OP detox

Cont. Has uncontrollable withdrawal symptoms Has an acute physical or psychiatric illness Has multiple substance misuse Has a home environment unsupportive of abstinence (SIGN, 2003)

Clinic Times Broadford Hospital: 10.30-12pm 12pm Daily Portree Hospital: 2.30-4pm Daily Clinics will be held in Outpatient departments Cover will be provided by ward nursing staff out of hours and by CPN(A) at times of annual leave/sickness/training when possible Supervision, training and guidance will be provided by Alcohol Liaison Nurse

Format of Clinic Following attendance at GP/RP patient to attend next available clinic c slot Reducing dose of chlordiazepoxide will be supplied on daily basis s by ALN in line with SIGN guidelines and alcohol withdrawal assessment tool ALN will see patient daily for duration of detox where possible and continue to see as outpatient where appropriate On commencement of detox ALN will carry out detailed Alcohol Misuse Assessment and risk management Patient will be given written information regarding structure and purpose of OP detox

Format Written and verbal information will be given regarding medicines Patient will be asked to return unused medication the following day to reduce risk of misuse Patient required to sign contract agreeing to adhere to conditions ns of detox Patient will be breathalysed daily and positive reading will result in discharge

Statistics from first six months 83 patients attended. 54 had a history of in-patient detox 25 attended Broadford Hospital, 58 attended Portree. 45 completed the detox programme, 18 did not and 20 did not require detoxification and received a brief intervention. 19 patients were admitted for detox with an average length of admission of 2 days compared to a normal average of 5 days per admission. Of these admissions 16 occurred OOH without consultation with Alcohol Liaison Nurse. 38 patients attended seeking admission but only 13 were deemed appropriate for admission by Alcohol Liaison Nurse. 50 were self referrals, 6 referred by Social Work, 5 from CPN s,, 18 from GP s s and 4 from A&E.

Conclusion The development of a PGD for Chlordiazepoxide has allowed a nurse led service which alleviates the burden on medical staff. Self referral Drop-in system allows patients to access specialist service when they need it. Outpatient Detox Clinic has led to reduction in both number of admissions a to hospital for detox and length of admission. Patients report satisfaction at ease of access. Daily supply of Chlordiazepoxide reduces risk of misuse or overdose. ose.