Reducing Alcohol Related Harm by partnership working

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Reducing Alcohol Related Harm by partnership
working

• Clare Mylam RGN
• Former Alcohol Violence Liaison Nurse
• Oxford Radcliffe Hospital NHS Trust
• 5th November, 2008

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Aim of the Alcohol ViolenceLiaison nurse role

• To reduce alcohol related attendances by data
  sharing with partner agencies
• Develop a multi agency response safe follow up
  of people experiencing Domestic Abuse

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Key Objectives

• To ensure data is collected regarding the
  circumstances of victims and to recognise high
  risk venues vulnerable individuals
• Ensure anonymised data is transmitted to
  agencies in real time to allow for intervention
• Support front line reception staff in data
  collection at first point of contact with the
  patient
• Improve detection rates of alcohol related
  Violence in the Emergency Department by screening
  all patients
• Act as a resource to all staff within the Trust

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• To develop training packages for all nursing and
  clinical staff
• Work in collaboration with child protection teams
• Report back to monthly Clinical Governance
  meetings
• Improve patient care

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Implementing the project

• The finances were allocated to funding my role/
  travel expenses a lap top
• Receptionists were involved in design of the
  questionnaire
• Meetings were set up with the CDRP manager
  crime-analyst
• Promotional material in the form of posters
  news letters were distributed displayed
• Receptionists were advised to use their own
  judgement on appropriateness of completing forms
• Data was collected sent monthly to the CDRP
  distribution list
• I attended the night safe meetings

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Key people were added to the distribution list

• Domestic Violence Coordinators
• Substance misuse pharmacists
• 4 CDRP leads
• Police inspectors
• GOSE
• ED Consultant
• police crime analysts
• DAAT teams
• PCT)

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ViolencePatient sticky

• Date.......................Time...................
  ........................of assault
• Type of assault(Circle) Blunt/ Glass/
  Bottle/ Weapon
• 
  Pushed/ unknown/ Other...........................
• Body part used (assailant) Fist feet
  head
• Body part injured (Victim) Face Head
  Trunk Arms Legs
• Gender of assailant/s Male Female
  Both unknown
• Assault location Bar/ Pub/ Club/ Name
  of.........................................
• Street
  name..............................................
  ................
• 
  Town..............................................
  ...........................
• 
  Other.............................................
  ..........................
• Name of last pub drinking in......................
  .............................................

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Sample Data collection template
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Domestic Abuse child protection

• A pathway was developed to identify vulnerable
  carers with dependant children at home
• During a 2 year period over 300 children at risk
  were identified from carers with drug/ mental
  health/ alcohol/ Domestic abuse related issues.
  These children were not present at the time of
  their carers attendance to ED
• Over 60 cases of high risk DA were identified and
  referred to relevant agencies during a 5 month
  period
• The ED joined the Multi Agency Risk Assessment
  conference
• Teaching sessions were developed
• Links were made with maternity services

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6 month review changes

• The number of questionnaires completed fluctuated
  
• CDRP manager suggested removing a few questions
  from the Violence questionnaire
• The crime analyst altered the format
• The distribution list grew
• A meeting was set up with the PCT analysts and
  recommendations were made to improve quality of
  their data
• Media interest
• The licensing officers were making progress with
  problem licensed premises

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Project Summary

• Patterns were evident within the data
• 75 of sharp objects used in alcohol related
  assaults or accidents were glass or bottles
• The highest number of alcohol related assaults
  come from licensed premise
• The most common body part injured during alcohol
  related assaults was the face closely followed by
  the head
• Male mean age for alcohol related attendance
  27.5
• Female mean age 31
• The data added value to the police data.
• The city inspector only new about 25 of violent
  incidents presenting to the ED
• A particular night club sent approx 9 casualties
  to ED during a 2 week period, the data was
  actioned and only 1 casualty presented in the
  following 2 weeks

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The unexpected...

• Patients presenting to ED following DA were more
  likely to self discharge if not seen within 1hr
  of admission
• Lower rates of follow up were identified of DA
  maternity patients
• Alcohol services were aimed at 16-25 year. The
  data showed that 15 yr olds were more likely to
  present intoxicated.
• Female drinkers seemed to be prevalent in older
  age groups. I identified a lack of services to
  support women and services were unwittingly
  aimed at males

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• I found that vulnerable adults presenting to ED
  alone often had dependants left at home
• A pattern of alleged drink spiking became evident
• Harmful drinking games were identified
• Mugging patterns which the police were unaware of
  became evident
• Trends in types of weapons used were identified
• Community drug deaths could be predicted from
  patient presentations- ED joined the early
  warning system

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The End

• Clare.dines_at_a2dominion.co.uk
• Sanctuary worker for Cherwell, Oxfordshire
• Preventing homelessness when someone considers
  fleeing Domestic Abuse