Shared learning database

Doncaster & Bassetlaw Hospital NHS Foundation Trust
Published date:
January 2012

The Alcohol Nurse Specialist [ANS] service is an innovative and entrepreneurial nurse-led service that operates within a virtual multi-disciplinary, multi sector context; which responds to the spontaneous and complicated needs of patient target group.

This comprehensive service is provided by using treatment / care pathways as recommended by the National Treatment Agency for Substance Misuse, [DOH, 2005, 2007,] and incorporates the National Institute of Health and Clinical Excellence guidelines CG100 & CG115.

The aim is to achieve optimal wellbeing to those patients that are identified as having a problem with alcohol misuse or diagnosed with alcohol liver disease [ALD] and to facilitate this aim the ANS service delivers a Healthier Choices ALD Clinic.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To design and implement an alcohol nurse specialist led clinic that reflects the individual physical and psychosocial needs of the patients who are risk of /or suffering from alcohol liver disease. A clinic that will always, strive towards achieving optimal wellbeing of the patient; regardless of the stage of the disease. While at the same time, promoting health education, knowledge and informed consent of the patient through 'patient centred approaches' which endorses abstinence and harm reduction strategies that facilitates the patient to abstain or minimise damage to themselves and their families. 1. To promote optimal wellbeing for those patient suffering from alcohol liver disease and other alcohol related harm
2. Early diagnosis of alcohol liver disease [ALD]
3. To endeavour to prevent the condition becoming chronic
4. To conduct regular monitor through physical health signs, investigations and screening which are relevant to the stage of the alcohol liver disease identified
5. Early intervention through monitoring systems as identified by the patient's individual treatment plan
6. To promote an alcohol abstinent lifestyle choice.
7. Early diagnosis of harmful / dependant alcohol misuse
8. To ensure the patient understands the government message regarding safe drinking and the level of risk associate with alcohol consumption regarding alcohol related harm
9. Fast track access:-
a) Access to the relevant consultant at time of patient's appointment
b) Ward admission
c) Referral to all appropriate in house and community services
d) 'On the spot' supervision, consultation and advice for the nurse specialist from the consultant
10. Delivery of psychosocial brief and enhanced interventions
11. To establish a telephone help-line that operates within the service hours
12. Facilitate onward referrals to community services, which match the need of this complex patient group
13. Offer support to family and carers.

Reasons for implementing your project

Whilst working in my current role as a hospital alcohol nurse specialist [ANS], I anecdotally noted that men of 50-60 years of age were dying due to decompensated liver disease as opposed other groups of patients with liver disease. When speaking to these men or looking retrospectively into there notes, it appeared that the majority lived alone, had little or no support, had disengaged with services and did not appear to have been monitored on a regular basis by their GP.

In addition, I also noted that there was a cluster of deaths 4 to 6 weeks after Christmas or New Year celebrations. Having taken the alcohol histories from these patients they would often tell me that they had been abstinent all year but thought it 'OK' to 'just to have the odd one' at this time of year, or, they felt conspicuous drinking a none alcoholic beverage.

What became apparent after further investigation was that some patients where not regularly monitored by the GP regarding their ALD, the abstinent message 'got lost' as time past from the hospital admission or the last consultation with the gastroenterologist. Therefore, the patient would feel that it was OK to re-introduce alcohol into their daily activity at a reduced level [often at safe / low risk level] thinking that their liver had recovered and that they were not causing themselves any further harm.

I felt that there was a gap in service delivery, whereby an alcohol nurse specialist such as me could make contact with this patient target group in the outpatient clinic setting. Within this nurse led clinic it would enable me in my specialist role to review the physical, mental and social wellbeing of the patient and affect an appropriate treatment / care pathway, so in 2005 I set up the Healthier Choices ALD clinic.

How did you implement the project

A nurse led clinics were a relative new concept and conditions set by Trust were that all patients had to be under the care of a consultant attached to Bassetlaw Hospital, specific computer codes to administer the clinic had to be assigned. This proved to be difficult due to the fact that there was no established administration system that recognise nurse specialist within the computerised patient administration out patient system. A room then needed to be made available on the same day, at the same time as both gastroenterologists had their clinics and on the same corridor. The out patient department were able to accommodate all these requirements.

The clinic required a name, which was a challenge, others within administration attempted to name the clinic inappropriately i.e. alcohol misuse clinic. Also the title Alcohol Nurse Specialist on the appointment letters often caused distress. The emphasis of the clinic is the monitoring of the patient within a health promotion ethos; to minimise stigma and encourage engagement the clinic is named 'health promotion' and my role is simple identified as Nurse Specialist.

The consultants at the time allowed me to develop the clinic, but did not recognise its importance in regards monitoring ALD by an ANS or the need for psychosocial interventions to re-enforce the absence message. As the service developed, the consultants acknowledged the positives outcomes of the clinic and initiated referrals directly from their clinic. Overtime patients with fatty liver disease were also identified to attend the clinic with the gaol to prevent the disease progressing any further.

Regarding cost incurred; this is accrued by 5 hour clinic time set aside for the alcohol Nurse Specialist and 6 hour secretarial / administration time dedicated to the organisation of appointments and letters. The patient helpline is maintained within the ANS office hours.

Key findings

Clinic attendances are the only recorded evidence that has been taken - please see attachment.

The following outcomes are anecdotally agreed by those who have dealing with the clinic and the patients involved. One of the conclusions from completing this submission is that there will be specific data collections audits and measures put in place to support those outcome identified that can be quantified.

Positive outcomes include:
a) Increase in patient maintaining abstinence; now have patient up to 5 years alcohol free.
b) Improved health outcomes that have significantly improved the quality of life of the patient [added life] and family life.
c) Increased patient eligibility for liver transplantation.
d) Alcohol Nurse Specialist will at time see the patient rather than the consultant
e) Reduce hospital stay by fast tracking patient into hospital; rather than their condition having been allowed to deteriorate in the community and require more intense prolong treatment.
f) Patient gain insight to their condition and are able to make informed health decisions.

Key learning points

There is a need to collect robust data to evidence lifestyle, health outcomes, longevity and quality of life outcomes.

Before setting up the clinic, champions need to be identified, these need be gastroenterologists that fully support the concept of a nurse-led clinic and be willing to give their full support and regular clinical supervision to the ANS.

For the clinic to operate efficiently the Alcohol Nurse Specialist needs to be qualified to a degree level with the appropriate experience, knowledge and skill base.

Contact details

Valerie M Wood
Drug & Alcohol Liaison Nurse Specialist
Doncaster & Bassetlaw Hospital NHS Foundation Trust

Secondary care
Is the example industry-sponsored in any way?