1. NHS Responding to Alcohol- related Harm in Acute Hospitals : The Alcohol Specialist Nurse

2. Responding to Patients Needs  Need for a patient centered service.  Need to bridge primary secondary care boundaries.  Need for effective mechanisms of follow-up post inpatient treatment.  Need to respond quickly and effectively to complex needs.  Need to support & augment medical interventions.

3. Nurses best placed; but they come in many guises

4. Develop a competency framework that is congruent with desired outcomes  Completion of training needs analysis based upon review of current knowledge base and clinical experience.  Development and provision of training for nurses.  Identification of ongoing support mechanisms for contemporaneous health care staff.

5. Understanding partner needs  Agree local guidelines to support referrals to nurse led clinics.  Agree local guidelines to support referrals from nurse led clinics.

6. Practical Issues  Nurse responsibilities  Nurse autonomy  Nurse safety  Patient expectations  Multidisciplinary expectations –role legitimacy  AfC banding

7. All that done; how do we know if nurses are effective?

8. A prospective controlled cohort study: Brief Interventions for alcohol dependent patients in an acute hospital setting Authors: Owens, L., Cobain, K., Fitzgerald, R., Gilmore, I.T., Pirmohamed, M. The University of Liverpool

9. Introduction  Growing burden from alcohol-related harm  A paucity of evidence for effectiveness of treatment for alcohol dependent patients in acute settings  Need for investigation and robust testing of treatment modalities  Need to provide clinical guidance

10. Alcohol: The burden in Liverpool, UK  Burden of alcohol to the UK NHS – 12% A&E attendances (Pirmohamed et al 2000) 26% Intensive care admissions (Owens et al 2001) 4 th most common presenting problem in medical student case load

11. Alcohol: The burden in Liverpool, UK  Healthcare professionals and their attitudes – Professional scepticism – nurses & doctors Nurses are best placed to deliver interventions (Kaner 2004, Owens 2002) Limited knowledge and confidence (Owens et al 2000) Willingness to engage (Owens et al 2000, Brown et al 1997) Nurse intervention models (RCP 2001) Lack of structured response in acute hospitals (Owens et al 2005)

12. Method  Prospective cohort study (March 2007-March 2008)  2 UK NHS Hospital Trusts in NW of England treatment site (N=100) control site (N=100)  6 month follow-up  Recruitment simultaneous at two sites  Recruitment and treatment was by same Nurse (ASN)

13. Results 1: Demographics Intervention (%) Control (%) Female White British No Fixed Abode Single Lives Alone Employed Smokes 24 100 10 58 45 9 83 34 100 7 36 52 15 67

14. Results 2: Presenting Complaint Acute Alcohol Withdrawal Gastrointestinal Cardiovascular Mental Health Neurological Respiratory Genitourinary Musculoskeletal Accident & Injury Intervention 16 34 19 3 11 4 2 9 Control 12 27 25 11 13 0 1 10

15. Results 3: Difference in dependence baseline to follow-up Control Baseline Control Follow-up Treatment Baseline Treatment Follow-up 0 20 40 60 Severity of Alcohol Dependence Questionnaire Score

16. Results 4: Difference in alcohol consumption baseline to follow-up Control Baseline Control Follow-up Treatment Baseline Treatment Follow-up 0 50 100 150 Daily Alcohol Units

17. Statistical Results: Control versus intervention  Reduced alcohol consumption (p = 0.0001)  Reduced AUDIT score (p = 0.0001)  Reduced SADQ score (p = 0.0001)  Less A&E attendances (p = 0.023)  Lower length of hospital stay (p = 0.0001) * p values Wilcoxon Limitations Sample size Non-generalizability

18. Conclusions  This research adds to the emergent evidence on interventions for alcohol dependent patients in acute hospital settings BI may be an effective treatment for non treatment seeking alcohol dependent individuals BI are effective in reducing alcohol-related hospital admissions, hospital length of stay BI are effective in reducing alcohol consumption and dependence Nurses are ideally placed to deliver these interventions in this setting

19. Acknowledgements Professor M Pirmohamed Dr k Cobain Dr R Fitzgerald J Higgins S Chorley Alcohol Lifestyles Team Staff Patients and staff at both hospital sites