1522 Alcohol Consumption Documentation on Bradgate MHU Re-audit 2017/18

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1 1522 Alcohol Consumption Documentation on Bradgate MHU Re-audit 2017/18 Dr. Laura Carone, FY1 Dr Venkataramana Thiagarajan, GPVTS2 Dr. Mariam Benaris, Consultant Psychiatrist & audit team lead Dr James Tanner, Consultant Psychiatrist Dr Deenesh Khoosal, Consultant Psychiatrist Audit Period: July 2015 (1st Cycle) April 2017 (2nd Cycle) Report Date: November 2015 (1st Cycle) April 2017 (2nd Cycle)

2 Executive Summary Why the audit was undertaken The purpose of this audit was to determine how well alcohol use was being documented on admission to the Bradgate Mental Health Unit (BMHU), in an effort to help identify and support patients with alcohol dependence. How the audit was carried out During the month of July 2015, we looked at the clerking documentation across the eight inpatient wards at BMHU and selected five patients at random from each ward. Using RiO, each of those patients clerking paperwork and progress notes were used to answer a specific group of questions, based upon the World Health Organisation s Alcohol Use Disorders Identification Tool (AUDIT) (Appendix 1.) Re-audit took place in April 2017, again a random selection of five patients from each ward were included. Key findings: Of the 40 patients we collected data from: a) 75% of patients had documented evidence of how many drinks they had on a typical day of drinking, this is an improvement from 53% compared with the baseline. Key actions from re-audit No actions required: Quality Improvement actions targeting this area of practice are being implemented as part of the National CQUIN 9 - Preventing Risky Behaviours - alcohol and tobacco, and POMH UK topic 14 - Prescribing for substance misuse: alcohol detoxification Re-audit date Re-audit not required - this area of care/practice is addressed by: National CQUIN 9 - Preventing Risky Behaviours - alcohol and tobacco, and POMH UK topic 14 - Prescribing for substance misuse: alcohol detoxification 2 of 7 Executive Summary 2017/18

3 Background Aim In 2006, a paper by the Disability Rights Commission titled Equal Treatment: Closing the Gap highlighted a number of pitfalls in the quality of healthcare received by people with learning disabilities and/or mental health problems. [1] One of the key problems revealed was a suggestion that this cohort is substantially less likely to seek medical attention than the remainder of the population. This equates to a reduced life expectancy for people with a diagnosis of a major mental illness. As such, it has been widely accepted that each hospital admission should be taken as an opportunity to give these patients a thorough medical check. Physical health in-patients with mental health problems has been the focus of many debates and campaigns in the UK in recent years. In Leicester, alcohol related deaths and hospital admission rates are significantly higher than other areas in England. Leicester s Joint Health and Wellbeing Strategy document states that reducing harmful alcohol consumption is one of the main areas that needs to be addressed in order to reduce health inequalities. The annual cost to the NHS in Leicester due to alcohol related admissions exceeds 10 million. The aim of this audit is to improve our ability to identify those patients at risk of alcohol misuse and dependence. This will allow us to ensure that our patients have access to both inpatient and outpatient community alcohol treatment and support services. Criteria & Standards Table 1 - Criteria and standards Key: Full compliance 95% Partial compliance 90% <95% Minimal compliance <90% Method The WHO AUDIT questionnaire was used to devise a series of questions for identifying patients at risk of alcohol dependence. Using the RiO patient software system, we were able to select at random, 5 patients from each of the eight in-patient wards. In total, we looked through 40 patient s admissions paperwork and progression notes to complete the audit tool. The software has a specific section on the clerking pro forma, which corresponds to substance use including alcohol. We checked both this section and then in the progress notes for any documentation of alcohol consumption. Sample & data source Sample size n=40 Data source RiO patient software system, admissions documentation and progress notes. Audit type See Appendix 1 on p.6 for a copy of the audit tool Caveat During the baseline audit some of the questions on the WHO AUDIT questionnaire were quite specific (questions 5, 8 and 9 in particular) and may not routinely be asked as worded on the questionnaire in the course of a clinical interview. It may be expected that these questions may score less well than the other questions on the questionnaire that are often taught as important screening tools (CAGE questions) throughout medical training. 2017/18 Background 3 of 7

4 During this re-audit, due to the above, each individual WHO screening question was removed from the re-audit as it was felt it was not appropriate or proportionate to expect each patient to be asked all the WHO questions as part of their admission clerking. Service areas / teams included Bradgate Mental Health Unit inpatient wards only. Findings Table 1 - Results comparison - 16/17 baseline Vs 17/18 re-audit Criteria Patients who had documentation on how often a drink containing alcohol was taken Patients who had the number of drinks they had on a typical drinking day, documented in the notes compliance % variation 2016/ /18 52% 75% 23 30% 45% 15 Comments AUDIT, The Alcohol Use Disorders Identification Tool, is a ten-question test developed by the World Health Organisation to help identify whether a patient is at risk of alcohol misuse or dependence. Its use is recommended by NICE. The 2016/17 baseline identified that the overall compliance of the Trust was low, with none of the questions achieving the minimum 90% compliance threshold. There was only documentation for just over half of our most vulnerable patients as to whether they consumed alcohol at all. This was a possible patient safety risk. Given the potential for missed disturbances in mental state secondary to alcohol withdrawal and the potential for inadequate prevention of alcohol withdrawal seizures in the early stages of admission, this was of prime importance to address. The 2017/18 re-audit showed there was an improvement from 52% to 75% in documentation in how often the patient drank alcohol. There was also a further improvement with only 22% of patients not being asked how much alcohol they drink compared to 30% in the first cycle. Despite these improvements, the 90% minimum compliance threshold has still not been met. Where results to be presented or discussed 1. LPT AMHLD CASE meeting 2. All in-patient Consultants at the Bradgate unit. 4 of 7 Findings 2017/18

5 Recommendations 1. No recommendations necessary. Quality Improvement actions targeting this area of practice are being implemented as part of the National CQUIN 9 - Preventing Risky Behaviours - alcohol and tobacco, and POMH UK topic 14 - Prescribing for substance misuse: alcohol detoxification References 1. Disability Rights Commission. Equal Treatment: Closing the Gap 2006.A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems. 2. Babor T.F, Higgins-Biddle J.C, Saunders J.B, Moneiro M.G. (2001) The Alcohol Use Disorders Identification Tool Guidelines for use in Primary care 2 nd Edition. World Health Organization, Department of Mental Health and Substance Dependence. 2017/18 Recommendations 5 of 7

6 Appendix 1 Audit 6 of 7

7 Appendix 2 Distribution list Target audience To (for action) Name, designation Medical staff Dr Benaris/ Tanner Cc (for info) Name, designation Appendix 3 Action plan No action plan required: Quality Improvement actions targeting this area of practice are being implemented as part of the National CQUIN 9 - Preventing Risky Behaviours - alcohol and tobacco, and POMH UK topic 14 - Prescribing for substance misuse: alcohol detoxification 7 of /18 Distribution list

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