Hospital Alcohol Liaison Seven Day Service – A pilot to reduce quality of care and Alcohol related admissions
Lancashire Teaching Hospitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Service Innovation - UHS Pharmacy an Opportunity to Increase the Coverage of ...Health Innovation Wessex
Getting To Grips with Alcohol 2016
Presentation Slides
Service Innovation - UHS Pharmacy an opportunity to increase the coverage of identification and brief advice
Jacqueline Swabe and Lindsay Steel
Service Innovation - UHS Pharmacy an Opportunity to Increase the Coverage of ...Health Innovation Wessex
Getting To Grips with Alcohol 2016
Presentation Slides
Service Innovation - UHS Pharmacy an opportunity to increase the coverage of identification and brief advice
Jacqueline Swabe and Lindsay Steel
Maternal & child mortality reduction (mcmr) by LACSOPJoshua Olufemi
An overview of study on availability and accessibility of facilities, equipment and personnel to support the Maternal & Child Mortality Reduction (MCMR) Programme in 20 Local Government Areas (LGAs) Lagos State.
Transforming clinical phamacy into a seven day serviceNHS England
This webinar gives an example of how the role Pharmacy services are improving patient care and flow across seven days a week.
Richard Cattell from NHS Improvement gave a national overview and weekend benchmarking information and Steve Brown, the regional lead from NHS Improvement & England gave some background information on the Carter Report.
Iain Davidson from Royal Cornwall NHS Trust and David Heller from Surrey and Sussex Healthcare NHS Trust describe the development of their respective weekend Pharmacy services and how this has improved patient care and flow
Being open for business: 7 day opening in Primary Care
Dr Ivan Benett - Clinical Director, Central Manchester CCG
GPwSI in Cardiology
& Care Clinical Champion for Healthier Together
Presentation from the 'NHS services open seven days a week: every day counts' event on Saturday 16 November at The Metropole Hotel, Birmingham.
This event was hosted by NHS Improving Quality and NHS England to share the views and ideas of public, patients, carers, NHS England and health and social care staff on how to improve access to services for patients across the seven day week.
More information at http://www.nhsiq.nhs.uk/improvement-programmes/acute-care/seven-day-services.aspx or #7DayServices
Transforming End of Life Care in Acute Hospitals AM Workshop 5: Summary Care ...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 5: Summary Care Record and highlights from updated Toolkit for Commissioning Person Centred End of Life Care presented by Dr Robert Jeeves, Health and Social Care Information Centre and Dianne Murray, NHS England
This review takes a look at some of the NHS England highlights over the last year, and includes real life case studies which show how the NHS put patients first.
Fully established on 1 April 2013, NHS England is an Executive Non-Departmental Public Body responsible for overseeing the running of the NHS. It aims to improve the health of people in England by working in an open, evidence-based and inclusive way, keeping patients at the heart of everything it does.
Maternal & child mortality reduction (mcmr) by LACSOPJoshua Olufemi
An overview of study on availability and accessibility of facilities, equipment and personnel to support the Maternal & Child Mortality Reduction (MCMR) Programme in 20 Local Government Areas (LGAs) Lagos State.
Transforming clinical phamacy into a seven day serviceNHS England
This webinar gives an example of how the role Pharmacy services are improving patient care and flow across seven days a week.
Richard Cattell from NHS Improvement gave a national overview and weekend benchmarking information and Steve Brown, the regional lead from NHS Improvement & England gave some background information on the Carter Report.
Iain Davidson from Royal Cornwall NHS Trust and David Heller from Surrey and Sussex Healthcare NHS Trust describe the development of their respective weekend Pharmacy services and how this has improved patient care and flow
Being open for business: 7 day opening in Primary Care
Dr Ivan Benett - Clinical Director, Central Manchester CCG
GPwSI in Cardiology
& Care Clinical Champion for Healthier Together
Presentation from the 'NHS services open seven days a week: every day counts' event on Saturday 16 November at The Metropole Hotel, Birmingham.
This event was hosted by NHS Improving Quality and NHS England to share the views and ideas of public, patients, carers, NHS England and health and social care staff on how to improve access to services for patients across the seven day week.
More information at http://www.nhsiq.nhs.uk/improvement-programmes/acute-care/seven-day-services.aspx or #7DayServices
Transforming End of Life Care in Acute Hospitals AM Workshop 5: Summary Care ...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 5: Summary Care Record and highlights from updated Toolkit for Commissioning Person Centred End of Life Care presented by Dr Robert Jeeves, Health and Social Care Information Centre and Dianne Murray, NHS England
This review takes a look at some of the NHS England highlights over the last year, and includes real life case studies which show how the NHS put patients first.
Fully established on 1 April 2013, NHS England is an Executive Non-Departmental Public Body responsible for overseeing the running of the NHS. It aims to improve the health of people in England by working in an open, evidence-based and inclusive way, keeping patients at the heart of everything it does.
3.1 Patient and public engagement - Dr Jim O'DonnellNHS England
Patient and public engagement. Engaging with patients and the public to shape and improve services. Featuring work Slough. Dr Jim O'Donnell. Chair, Slough CCG.
Innovations conference 2014 catherine adams integrating a multidisciplinary...Cancer Institute NSW
Catherine Adams - Integrating a Multidisciplinary Stepped Care Model of Psychosocial Care for Cancer Survivors and Families into routine Clinical Practice in Rural and Remote Regions
Keith Ridge, CBE Chief Pharmaceutical Officer
Presentation from the Winterbourne Medicines Programme Launch held in London on 10 September 2014
Ensuring safe, appropriate and optimised use of medication for people with learning disabilities who demonstrate behaviour that can challenge
We've produced an annual report for the West of England Academic Health Science Network to showcase how the organisation is helping to enhance healthcare delivery.
Anne Webster, -Clinical Lead Winterbourne Projects, NHS England,
Joanne McDonnell - Senior Nurse for Mental Health and Learning Disabilities, NHS England
Neil Hoskin - Expert by Experience, NHS England
Presentation from the Winterbourne Medicines Programme Launch held in London on 10 September 2014
Ensuring safe, appropriate and optimised use of medication for people with learning disabilities who demonstrate behaviour that can challenge
The NHS has a chronic access problem, linked to ever increasing demand for healthcare. This means that patients sometimes have to wait a long time for advice and treatment. Long waits run counter to modern consumer expectations and can have adverse clinical consequences. Community pharmacy – a walk in service located close to where people live, work and shop - must surely be part of the solution.
Improving quality, safety and lives - the Patient Safety Collaborative Programme 2014-2019
Presentation from Chief Nursing Officer for England's Summit 2014
26 November 2014
Similar to Hospital Alcohol Liaison Seven Day Service (20)
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
Commissioning Integrated models of care 160211 slides
Hospital Alcohol Liaison Seven Day Service
1. Hospital Alcohol Liaison Seven Day Service – A Pilot to Improve
Quality of Care And Reduce Alcohol Related Hospital Admissions
Hospital Alcohol Liaison Service (HALS)
Lancashire Teaching Hospitals NHS Foundation Trust
Aims and Objectives
In 2010/11 alcohol related harm cost the NHS in Lancashire £141.92 million.
Reducing alcohol related hospital admissions is a priority nationally and locally. The public
health outcomes framework 2013-16 identifies reducing alcohol related hospital admissions
as a health improvement indicator.
In central Lancashire alcohol related hospital admissions have increased annually from
2005/06 up to 2010/11.
In 2010/11 Preston had the highest rate of hospital admissions for alcohol related liver
disease in the North West.
Prior to April 2013 there was no Hospital Alcohol Liaison Service (HALS) for Lancashire
Teaching Hospitals NHS Trust.
The aim of the service is to reduce alcohol related hospital admissions by
•
Reducing the rate of increase in alcohol related hospital emergency attendances
•
Reducing the rate of increase in alcohol specific hospital admissions
•
Reducing the length of hospital stay for alcohol specific hospital admissions
•
Facilitating improved clinical pathways and co-ordinated discharges, and in doing
so increasing patient access and engagement with primary care and community
specialist substance misuse services.
The objectives include:
•
Development of appropriate pathways and protocols to support delivery of HALS
•
Training to support ‘front line’ clinical and nursing staff implement alcohol use
screening using Alcohol Use Disorders Identification Toolkit (AUDIT) and deliver
opportunistic brief interventions and brief advice for all patients
•
Implementation of Hospital Alcohol Liaison Service across all Lancashire Teaching
Hospitals adult wards and departments.
From April 2013 HALS have carried out the comprehensive assessment of patients who have
attended the Emergency Dept (ED) or have been admitted to the wards of the Royal Preston
Hospital and Chorley District Hospital and who score 8 or above on the AUDIT, seven days
per week. Referrals can be made 24 hours per day by means of bleep, voicemail or diaries
kept in ED departments.
Types of Alcohol Misuse
150
28
0
31
10
0
27
16
0
7
15
18
11
50
68
66
26
22
25
14
Apr-13
May-13
Jun-13
Jul-13
Aug-13
1
23
100
50
0
Low Risk
Dependent
Harmful
Hazardous
0
27
15
70
unknown
Data collection started from 8th April. Work commenced with IT and data analysis to
develop a data base.
It was evident on the commencement of the team that there was a culture in the hospital
of delayed discharge due to patients being on a reducing regime of Chlordiazepoxide, if
medically fit the majority of patients were being kept in to complete this regime, regardless
of whether the patients wanted to stop drinking and often were not being offered follow
up in the community, leading to relapse and re attendance at hospital seeking further
detoxification. HALS were able to identify these patients and using assessment tools
advise on whether patients could be discharged safely with follow up from community
services. Numbers of bed nights saved have been calculated using the severity of alcohol
dependency questionnaire (SADQ) and the Clinical Institute Withdrawal Assessment
(CIWA) to determine whether the patient would have needed a mild to moderate reducing
regime (5 days) or a severe regime (7days), using the existing clinical guideline for assisted
withdrawal for LTHTR.
Number of Bed Nights Saved by Month
134
77
19
87
123
The Team
Apr-13
HALS started on the 8th April 2013
with two team members, Emma
Dermody, Clinical Lead Specialist
Nurse, previously employed by Greater
Manchester West mental health NHS
Foundation Trust (GMW) as the Alcohol
Liaison Nurse for the Royal Bolton
Hospital, and Keighley Allan, Clinical
Nurse Specialist, previously employed
by GMW as a Substance Misuse
Practitioner working for community
substance misuse service in Preston.
They were joined by Kerry Anderson,
previously a sister in the Emergency
Department on the 22nd April and then by Angela Platt on the 20th May, previously Senior
Substance Misuse Nurse at Preston Prison, employed by GMW.
The team cover two sites, Royal Preston Hospital and Chorley District Hospital and work
seven days per week. Weekends were covered from the 4th May.
Progress
Referrals were taken from 8th April;
pathways were developed quickly to
cope with demand for the service.
Total referrals to 31.10.13 are 813.
Number of Referrals by Gender
140
120
100
80
60
40
20
0
83
34
17
Apr-13
95
97
89
45
36
35
37
May-13
Jun-13
Jul-13
Aug-13
Female
Male
Referral criteria - patients who score 8
or above on the Alcohol Use Disorders
Identification Tool (AUDIT). This tool
was already in use in the Integrated
Care Pathway documentation (ICP) on
the wards. The AUDIT – C was in use in
the Emergency Department (ED)
Across both sites the team visit ED daily and throughout the day to check for referrals, key
wards, including the Medical Assessment Units and the Gastroenterology wards are visited
daily in the morning to check for referrals.
An assessment tool has been developed for use by the team to help identify type of alcohol
misuse, level of dependency, severity of withdrawal, other needs and risks. This allows
appropriate interventions, evidence based good practice and assessment of motivation.
Appropriate community services and solutions can then be offered for any unmet need
which may have contributed to attendance at hospital.
May-13
Jun-13
Jul-13
Aug-13
Improved referral pathways with community services have been developed. HALS are
currently able to refer patients, based on need, risk and motivation to the right part of the
treatment service. In appropriate cases community services have continued detoxification
at home on discharge. A Process Mapping Event was held in July with community and
hospital nursing, managers and medical staff, to identify where pathways can be improved.
Joint working has been developed with the senior outreach worker from Discover
community services, who was offering a clinic to ED prior to HALS, making better use of
his time at the hospital.
Pathways developed with the Mental Health Liaison Service, joint assessments taking
place when possible.
Work has taken place to standardise assessment and referral criteria with HALS from
Southport and Ormskirk hospital.
Programmes for teaching rolled out to key areas, topics including introduction to HALS,
AUDIT screening, brief interventions and alcohol detoxification. Teaching delivered to FY1
and FY2 doctors as part of the rolling programme for induction. Teaching also delivered
to nurses as part of the preceptorship programme.
Work has been commenced on the NCEPOD recommendations for Alcohol related liver
disease with Dr Sharma, Consultant Physician and Gastroenterologist, including the
development of a daily multi- disciplinary care team meeting.
Work has been commenced with data analysis identifying high impact users. For those
high impact users already identified by the team, case management meetings set up with
community services to flag up the issue of repeat attendances and to devise alternative
plans. For those not already known, appropriate referrals on to relevant services.
What is the feature of your work that you feel best demonstrates
energy, imagination and innovation?
April – October 2013 a total of 813 patients were referred, the majority receiving
comprehensive assessment of need, on the same day or following day of referral, and
an appropriate intervention, including referral to substance misuse services, brief
interventions, referral to other community services and close monitoring of detoxification
if admitted for other medical reasons. HALS will work with patients whatever their level
of motivation. A hospital admission is seen as a window of opportunity. HALS provide
a menu of options designed to help people improve any social problems and health
outcomes for the future.
Effective and supportive clinical leadership has enabled HALS to start a service from scratch,
with clear aims and objectives and ensuring there were no barriers to the introduction of
the service and backing all changes to existing pathways