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Improving the care and management of patients with alcohol dependency in the emergency departmentThe Alcohol Care Team at Sandwell and West Birmingham NHS Trust provides a multifaceted, holistic, evidenced-based approach to alcohol-related health problems that affect, not only an individual’s health and psychological and socioeconomic wellbeing, but also that of their family. Working on an outpatient basis, the nurse-led team encourages patients to take control of their own recovery and work in partnership with their family and the team to achieve positive long-term outcomes.
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Peri-operative management of alcohol withdrawal with ethanol prescribing : a case studyNo abstract available.
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Oral ethanol prescribing for alcohol withdrawal syndrome : initial findings and future directions following implementation within a United Kingdom National Health Service settingIntroduction: Prescribing of ethanol may be an alternative to benzodiazepines for managing alcohol withdrawal syndrome. We present our experience of oral ethanol prescribing within an acute United Kingdom National Health Service setting. Methods: A retrospective review of patients presenting with alcohol withdrawal who were managed with oral ethanol or benzodiazepines was performed from data collected across two acute care settings. Ethanol prescribing inclusion: high risk of delirium tremens, or a history of harmful alcohol consumption (typically ≥30 units/day; in which 1 unit = 8 grams of alcohol; one standard United States drink = 14 grams of alcohol) or known to have a history of severe alcohol withdrawal, alcohol-related seizures or delirium tremens. Inverse propensity score weighting was used to partially account for variance between the two patient populations. Results: Fifty (82 per cent male; average age 50.9 years) and 93 (84 per cent male; average age 46.5 years) patients in receipt of benzodiazepines or ethanol, respectively, were included. The likelihood of hospital admission was significantly reduced when individuals were managed with ethanol (odds ratio 0.206 (95 per cent confidence interval; 0.066-0.641), Wald chi-square P = 0.006). In those not admitted, the treatment type had no significant impact on length of stay or the number of occasions a pharmacological agent was required. In those admitted, treatment had no significant effect on length of stay. Discussion: We offer preliminary evidence to support a role of oral ethanol in the management of patients with alcohol withdrawal. We have implemented a robust and translatable guideline. Despite limitations in the data set the impact of ethanol in reducing the likelihood of admission remained significant. Conclusions: In individuals at significant risk of severe alcohol withdrawal, prescribing ethanol as part of a comprehensive care plan, may reduce unplanned admissions. The preliminary findings presented here warrant further assessment through prospective studies.
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An audit to assess the impact of prescribing a monofilament fibre debridement pad for patients with unhealed wounds after six months.A monofilament fibre debridement pad has been found to be a rapid and effective mechanical method of removing dry skin, biofilm and debris from acute and chronic wounds with minimal patient discomfort. Evidence of its impact on prescribing and wound healing, however, has been more limited. The aim of this audit was to show evidence of the monofilament fibre debridement pad's impact on wound treatment costs through an analysis of NHS wound-care prescribing data in England. A dataset for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad was obtained from the NHS Business Services Authority. All data were anonymised. Costs were identified for the six months before and six months after the month of first prescription of the monofilament fibre debridement pad. The total cost of wound-care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 (n=486) after. These results indicate that use of the monofilament fibre debridement pad could reduce prescribing costs and the use of antimicrobial and negative pressure therapies. Further research is warranted to investigate the clinical role of the monofilament fibre debridement pad in wound healing.
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An advanced self-care delivery model for leg ulcer management: a service evaluation.Background: Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs, with a cost burden of over £3 billion each year. Objective: The aim of this service evaluation was to assess the effects of implementing a self-care delivery model on clinical outcomes with the intention of limiting face-to-face health professional contact to one appointment every 6 weeks. Method: A suitability assessment was conducted and a cohort of patients were moved to a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous report. Results: This highlighted that, in 84 of the 95 patients selected, the VLUs had healed by week 24 on the pathway, a further 10 patients' VLUs had healed by week 42 and only one remaining patient reached 42 weeks without healing. Conclusion: These results support the hypothesis that patients with VLUs can self-care and deliver clinical effectiveness. It is recommended that all services explore the possibility of introducing a self-care model for VLU care.
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The Alcohol Care Team model : a holistic approach to address alcohol dependence and withdrawalAlcohol-related ill health is an important cause of acute hospital presentations. Service demand and resource limitations often lead to a reactive rather than proactive approach in the ED and acute medical units. For the patient, perceived and real treatment barriers can result in disillusionment, despair, repeat attendance, deteriorating health, and, ultimately, disproportionately high mortality rates. An Alcohol Care Team (ACT) is a dedicated group of hospital-based specialist nurses and practitioners experienced in the timely identification, assessment, and management of a range of alcohol-related conditions and their complications. An ACT can help improve both patient outcomes and service delivery performance through a targeted holistic approach that recognizes the complexities of addiction and the need for the patient to be the driver of lifestyle change. The ACT works with existing community-based alcohol service providers to optimize patient experience, outcomes, and resource use in addressing alcohol-related care needs. The authors present outcomes from the first 5 years of the ACT at the Sandwell and West Birmingham (SWB) National Health Service Trust. Implemented in 2018, the SWB ACT now consists of 11 core members of the staff delivering timely assessment and interventions for individuals presenting to acute services with alcohol-related health problems, as well as delivering outpatient support and guidance after discharge. Key milestones in the ACT’s inception, growth, and development are highlighted, all of which align with the achievement of performance targets, outcome measures (including the number of inpatient bed days avoided, the percentage of patients reviewed within 1 hour acutely or 24 hours if admitted, income generated through clinical work, and avoidance of admission), and improvements in care from a hospital resource distribution and patient satisfaction perspective. This model is translatable to other regions and settings. Key steps that other organizations might take toward developing an ACT are outlined.