Navigation

Medically assisted alcohol withdrawal - setting

Quality statement

People needing medically assisted alcohol withdrawal are offered treatment within the setting most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

Quality measure

Structure

a) Evidence of local arrangements to ensure that people who need medically assisted alcohol withdrawal are offered treatment within the setting most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

b) Evidence of local commissioning arrangements for provision of community-based medically assisted alcohol withdrawal in accordance with local need.

c) Evidence of local commissioning arrangements for provision of residential and inpatient medically assisted alcohol withdrawal, including provision for children and young people, and people with highly complex needs such as those at high risk of severe alcohol withdrawal syndromes, and/or with severe physical or psychiatric comorbidity.

d) Evidence of local arrangements to ensure that people in vulnerable groups who are in acute alcohol withdrawal are considered for admission to hospital for medically assisted withdrawal.

Process

a) Proportion of adults needing medically assisted alcohol withdrawal not requiring an inpatient or residential setting, who complete a successful community-based withdrawal.

Numerator - the number of people in the denominator completing a successful community-based medically assisted alcohol withdrawal.

Denominator - the number of adults needing medically assisted alcohol withdrawal not requiring an inpatient or residential setting.

b) Proportion of people needing medically assisted alcohol withdrawal meeting criteria for inpatient or residential care who complete a successful withdrawal in an inpatient or residential setting.

Numerator - the number of people in the denominator completing successful medically assisted alcohol withdrawal in an inpatient or residential setting.

Denominator - the number of people needing medically assisted alcohol withdrawal meeting criteria for inpatient or residential care.

c) Proportion of people in defined groups in acute alcohol withdrawal who are admitted to hospital for medically assisted withdrawal.

Numerator - the number of people in the denominator admitted to hospital for medically assisted withdrawal.

Denominator - the number of people in defined groups in acute alcohol withdrawal.

Outcome

a) Proportion of people undergoing medically assisted alcohol withdrawal (planned or unplanned) who complete withdrawal successfully and without complications.

Numerator - the number of people in the denominator completing medically assisted withdrawal successfully and without complications.

Denominator - the number of people undergoing medically assisted alcohol withdrawal (planned or unplanned).

b) Decrease in quantity and frequency of alcohol consumption in people needing medically assisted alcohol withdrawal.

Description of what the quality statement means for each audience

Service providers ensure that people needing medically assisted alcohol withdrawal are referred to and treated in the setting (community, residential or inpatient) most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

Healthcare professionals ensure they care for people needing medically assisted alcohol withdrawal in the setting (community, residential or inpatient) most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

Commissioners ensure they commission services with adequate residential, inpatient and community-based capacity to enable their local population needing medically assisted alcohol withdrawal to be treated within the setting most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

People needing medically assisted alcohol withdrawal are cared for in the place most appropriate to their needs, for example, this may be at home, in a clinic or in hospital.

Source clinical guideline references

NICE clinical guideline 115 recommendations 1.3.4.2, 1.3.4.5, 1.3.4.6 and 1.3.7.5.

NICE clinical guideline 100 recommendations 1.1.1.1 (key priority for implementation) 1.1.1.2 and 1.1.1.3.

Data source

Structure

a), b), c) and d) Local data collection.

Process

a) Local data collection for denominator. The National Alcohol Treatment Monitoring System (NATMS) collects intervention type for people who present to specialist alcohol services and then start structured treatment. ‘Alcohol - community prescribing interventions' is one of the interventions that can be recorded.

b) Local data collection for denominator. The NATMS collects data on the number of people receiving inpatient treatment for alcohol misuse (adults) and whether a person is in a substance misuse treatment specific residential placement(children and young people). The offer of inpatient or residential withdrawal (rather than programme completion) is contained within NICE clinical guideline 115: audit support criteria 5 and 16.

c) Local data collection. The International statistical classification of diseases and related health problems (ICD-10) code for alcohol withdrawal state with delirium is F10.4. Contained within NICE clinical guideline 100: audit support criteria 1 and 2.

The NHS Information Centre statistics on alcohol in England reports on items prescribed for the treatment of alcohol dependence, including the setting in which they are prescribed.

Outcome

a) Local data collection. The International statistical classification of diseases and related health problems (ICD-10) code for alcohol withdrawal state with delirium is F10.4.

b) Local data collection. Data on prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England.

Definitions

NICE clinical guideline 115 recommends the following:

Service users who need assisted withdrawal should usually be offered a community-based programme, which should vary in intensity according to the severity of the dependence, available social support and the presence of comorbidities:

  • For people with mild to moderate dependence, offer an outpatient-based assisted withdrawal programme in which contact between staff and the service user averages 2-4 meetings per week over the first week.
  • For people with mild to moderate dependence and complex needs (for example, psychiatric comorbidity, poor social support or homelessness), or severe dependence, offer an intensive community programme following assisted withdrawal in which the service user may attend a day programme lasting between 4 and 7 days per week over a 3-week period.

Consider inpatient or residential assisted withdrawal if a service user meets one or more of the following criteria. They:

  • drink over 30 units of alcohol per day
  • have a score of more than 30 on the SADQ
  • have a history of epilepsy, or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes
  • need concurrent withdrawal from alcohol and benzodiazepines
  • regularly drink between 15 and 20 units of alcohol per day and have:
    • significant psychiatric or physical comorbidities (for example, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease) or
    • a significant learning disability or cognitive impairment.

Also consider a lower threshold for inpatient or residential assisted withdrawal in vulnerable groups, for example, homeless and older people.

Offer inpatient care to children and young people aged 10-17 years who need assisted withdrawal.

NICE clinical guideline 100 recommends that people in acute withdrawal with, or assessed to be at high risk of developing, alcohol withdrawal seizures or delirium tremens, should be offered admission to hospital for medically assisted alcohol withdrawal. A lower threshold for admission to hospital for medically assisted withdrawal should also be considered in certain vulnerable people, for example people who:

  • are frail
  • have cognitive impairment
  • have multiple comorbidities
  • lack social support
  • have learning difficulties
  • are 16 or 17 years.

Young people under 16 years who are in acute alcohol withdrawal should be offered admission to hospital for physical and psychosocial assessment, in addition to medically assisted alcohol withdrawal.

Equality and diversity considerations

A lower threshold for inpatient assisted withdrawal, whether planned or unplanned, should be considered for people who are homeless, older people and children and young people, to ensure their safety.

This page was last updated: 25 August 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.