POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
43
Initial assessment
Audit standard 1:
The decision to undertake acute alcohol detoxification of an inpatient should be informed by:
a. A documented assessment of drinking history and current daily alcohol intake (derived from NICE CG 115, recommendation 1.3.4.5).
b. A physical examination, carried out on admission (derived from NICE CG 115, 1.2.2.10).
Audit standard 2:
Blood tests relevant to the identification of alcohol-related physical health problems (e.g. liver function tests including GGT, albumin and clotting, full blood count, glucose and renal function tests) should be carried out during the admission (derived from NICE CG 115, 1.2.2.10).
Treatment target 1:
Breath alcohol should be measured as part of the initial assessment for alcohol detoxification (derived from NICE CG 115, recommendation 1.2.2.9).
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
44 Figure 6: Proportion of patients who had a documented assessment of drinking history at admission
The Trusts are ordered on the basis of the proportion of patients in the sample who had a documented assessment of drinking history. The proportion of patients in a Trust sample who had a documented assessment of drinking history varied from 100% to 11%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
012 019 025 085 090 109 013 100 098 020 027 029 018 005 042 059 080 017 104 068 074 092 016 015 084 022 008 021 079 073 102 003 034 051 089 054 094 050 066 077 009 062 072 TNS
Proportion of patients
Trust number
Not documented
Documented assessment
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
45 Figure 7: Proportion of patients who had a documented physical assessment at admission
The Trusts are ordered on the basis of the proportion of patients in the sample who did not have a documented physical assessment. The proportion of patients in a Trust sample who did not have a documented physical assessment varied from 0% to 50%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
005 012 018 019 066 085 090 092 094 098 062 073 072 084 034 102 080 022 003 051 021 027 016 013 100 059 104 009 020 068 029 109 079 008 089 042 074 015 017 025 054 050 077 TNS
Proportion of patients
Trust number
Not documented
The patient declined physical examination
Documented assessment
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
46 Figure 8: Proportion of patients who had documented assessments of the signs and symptoms of Wernicke’s encephalopathy
The Trusts are ordered on the basis of the proportion of patients in the sample who did not have any documented assessments for the signs and symptoms of Wernicke’s encephalopathy. The proportion of patients in a Trust sample who did not have any documented assessments for the signs and symptoms of Wernicke’s encephalopathy varied from 0% to 100%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
019 018 012 085 098 090 062 013 022 027 003 066 073 042 100 084 080 005 094 102 050 029 034 089 017 059 008 021 074 015 079 104 051 020 025 016 009 092 054 109 068 072 077 TNS
Proportion of patients
Trust code
No signs/symptoms were assessed
Some
signs/symptoms were assessed
All signs/symptoms were assessed
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
47 Figure 9: Proportion of patients who had a documented breath alcohol measurement
The Trusts are ordered on the basis of the proportion of patients in the sample who had a documented breath alcohol measurement. The proportion of patients in a Trust sample who had a documented breath alcohol measurement varied from 100% to 0%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
019 017 013 018 077 094 029 025 098 109 062 042 073 104 034 005 051 059 022 027 074 015 090 054 080 084 068 102 021 016 100 092 089 085 079 072 066 050 020 012 009 008 003 TNS
Proportion of patients
Trust code
No record
Documented measure
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
48 Figure 10: Proportion of patients who had documented liver function tests during admission
The Trusts are ordered on the basis of the proportion of patients in the sample who had documented liver function tests during admission. The proportion of patients in a Trust sample who had documented liver function tests varied from 100% to 56%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
003 009 012 019 077 085 090 092 094 098 018 084 015 102 100 080 050 109 089 029 005 022 034 027 074 059 016 066 062 013 017 054 072 104 020 051 021 042 073 008 079 025 068 TNS
Proportion of patients
Trust code
No record
Documented assessment
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
49
During admission
As only 2 patients were prescribed phenytoin in the total national sample, we have not provided a trust level graph for this standard.
Audit standard 5:
Thiamine should be prescribed parenterally for inpatients in acute alcohol withdrawal.
Audit standard 3:
Pharmacotherapy to treat the symptoms of acute alcohol withdrawal should be limited to a benzodiazepine, carbamazepine or clomethiazole (derived from NICE CG 100, 1.1.3.1 and NICE CG 115, 1.3.5.3).
Audit standard 4:
Phenytoin should not be prescribed to prevent or treat alcohol withdrawal seizures (NICE CG 100, 1.1.5.3 and BAP evidence-based guidelines for the pharmacological management of substance abuse, 2012).
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
50 Figure 11: Proportion of patients who were prescribed medication recommended by NICE for managing
symptoms of acute alcohol withdrawal
The Trusts are ordered on the basis of the proportion of patients in the sample who were prescribed at least one drug to treat the symptoms of acute alcohol withdrawal. The proportion of patients in a Trust sample who were prescribed at least one drug to treat the symptoms of acute alcohol withdrawal varied from 100% to 0%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
005 009 012 013 015 019 020 025 027 029 034 042 050 051 062 066 072 077 079 085 090 092 094 098 100 102 018 074 073 059 080 016 054 003 104 022 089 109 008 017 021 084 068 TNS
Proportion of patients
Trust code
No medication prescribed
At least one medication prescribed
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
51 Figure 12: Proportion of patients who had thiamine prescribed parenterally
The Trusts are ordered on the basis of the proportion of patients in the sample who were prescribed thiamine parenterally.
The proportion of patients in a Trust sample who were prescribed thiamine parenterally varied from 100% to 0%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
012 019 085 090 016 018 098 094 104 027 080 073 042 003 079 017 013 025 072 022 077 029 074 068 059 062 021 008 005 050 102 051 066 089 084 015 054 009 092 109 034 100 020 TNS
Proportion of patients
Trust code
Not prescribed
Prescribed orally
Prescribed parenterally
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
52 Figure 13: Proportion of patients whose alcohol detoxification was completed as planned
The Trusts are ordered on the basis of the proportion of patients whose alcohol detoxification was completed as planned. The proportion of patients in a Trust sample whose alcohol detoxification was completed as planned varied from 100% to 0%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
019 059 077 085 090 092 018 003 062 072 094 013 098 009 025 073 042 016 051 027 005 074 079 068 017 029 104 084 066 054 034 050 021 008 100 102 080 020 089 109 015 012 022 TNS
Proportion of patients
Trust code
Not documented/
unknown
Patient declined detoxification and/or self-discharged
Detoxification was terminated by medical staff
Completed alcohol detoxification regimen as planned
POMH-UK (2014) Topic 14a. Prescribing for substance misuse: alcohol detoxification.
53