Management of medically assisted withdrawal from alcohol in acute adult mental health and specialist addictions in-patient services: UK clinical audit findings

BACKGROUND: Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards.

AIMS: Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services.

METHOD: Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool.

RESULTS: Forty-five National Health Service (NHS) mental health trusts/healthcare organisations submitted data relating to the treatment of 908 patients undergoing MAAW on an acute adult ward or psychiatric intensive care unit (PICU) and 347 admitted to a specialist NHS addictions unit. MAAW had been overseen by an addiction specialist in 33 (4%) of the patients on an acute adult ward/PICU. A comprehensive alcohol history, measurement of breath alcohol, full screening for Wernicke's encephalopathy, use of parenteral thiamine, prescription of medications for relapse prevention (such as acamprosate) and referral for specialist continuing care of alcohol-related problems following discharge were all more commonly documented when care was provided on a specialist unit or when there was specialist addictions management on an acute ward.

CONCLUSIONS: The findings suggest that the quality of care provided for medically assisted withdrawal from alcohol, including the use of evidence-based interventions, is better when clinicians with specialist addictions training are involved. This has implications for future quality improvement in the provision of MAAW in acute adult mental health settings.

addictions psychiatry, Medically assisted alcohol withdrawal, quality improvement, thiamine, Wernicke's encephalopathy

10.1192/bjo.2023.45

2056-4724

Sinclair, Julia

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Barnes, Thomas R E

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Lingford-Hughes, Anne

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Drummond, Colin

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Loubser, Ignatius

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Rendora, Olivia

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Paton, Carol

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11 April 2023

Sinclair, Julia

be3e54d5-c6da-4950-b0ba-3cb8cdcab13c

Barnes, Thomas R E

3ae0ce78-0404-47dc-b54f-795ba8235e0e

Lingford-Hughes, Anne

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Drummond, Colin

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Loubser, Ignatius

06120828-8d55-49f0-818a-9e3f9d4b3abb

Rendora, Olivia

c176c58c-7fb2-4051-a28c-7e0bb62749f5

Paton, Carol

043a1435-5b76-4992-9567-5489a93ffe4a

Sinclair, Julia, Barnes, Thomas R E, Lingford-Hughes, Anne, Drummond, Colin, Loubser, Ignatius, Rendora, Olivia and Paton, Carol (2023) Management of medically assisted withdrawal from alcohol in acute adult mental health and specialist addictions in-patient services: UK clinical audit findings. BJPsych Open, 9 (3), [e61]. (doi:10.1192/bjo.2023.45).

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Abstract

BACKGROUND: Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards.

AIMS: Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services.

METHOD: Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool.

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e-pub ahead of print date: 11 April 2023

Published date: 11 April 2023

Additional Information: Funding Information: J.S. is the National Specialty Advisor for Alcohol Dependence to NHS England. C.D. has received funding from the Medical Research Council, the Department of Health and Social Care National Institute for Health and Care Research (NIHR) and the European Commission; he was supported by the NIHR Specialist Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London, the NIHR Collaboration for Leadership in Applied Health Research and Care at King's College Hospital NHS Foundation Trust and the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust; he is in receipt of an NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. A.L.-H. reports honoraria for speaking engagements and/or attendance at conferences from Lundbeck, Lundbeck Institute UK, Pfizer and Servier; she has received research grants or support from Alcarelle and Lundbeck; she is a member of the British Association for Psychopharmacology and receives honoraria for speaking at educational events and led their ‘addiction’ guidelines, which received support from Archimedes Pharma, Lundbeck, Pfizer and Schering. Publisher Copyright: Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Keywords: addictions psychiatry, Medically assisted alcohol withdrawal, quality improvement, thiamine, Wernicke's encephalopathy