OUTPATIENT DETOX CLINIC

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OUT-PATIENT DETOX CLINIC

• NEIL TURNER ALCOHOL LIAISON NURSE

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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)

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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

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Aim
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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

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• 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
• To encourage engagement with alcohol support
  services
• To provide appropriate educational support and
  information to patients

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Referral Criteria

• Referrals to the service will be accepted from
  the following
• GPs
• Rural Practitionerss
• Self

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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

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Exclusion Criteria

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

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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

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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)

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Clinic Times

• Broadford Hospital 10.30-12pm 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

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Format of Clinic

• Following attendance at GP/RP patient to attend
  next available clinic slot
• Reducing dose of chlordiazepoxide will be
  supplied on daily basis 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

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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 of detox
• Patient will be breathalysed daily and positive
  reading will result in discharge

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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 CPNs, 18 from GPs and 4 from AE.

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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 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.