Download Guidelines for doctors to the correct procedure in organising a tail

Protocol for discharge to
Community Alcohol
Detoxification
Name………………………………………………..
UR no……….………….……………………………
AFFIX ID LABEL
Patients requesting an admission purely for an Alcohol Detoxification should be directed to
community Services via their G.P. and not admitted unless medically unwell.
Guidelines for doctors to the correct procedure in organising a tail-end detoxification in the
community for patients who have completed a number of days of the detoxification regime as an inpatient. Please involve the Alcohol Liaison Team at as early a stage as possible – Fax
Referral Form (Pg.5) to 6748.
Patient Inclusion Criteria
1
2
3
Alcohol dependent individuals requiring medication to safely stop alcohol use.
Patient expressing wish to abstain from alcohol.
Patient medically fit for discharge and has completed 3 days of detoxification in
hospital setting.
4
5
NO history of delirium tremens on this admission.
6
Patient willing to engage in Alcohol Liaison Team follow up as out-patient.
1
2
YES
Initials
NO significant acute medical/mental health problems.
Procedure
Assess patient inclusion criteria.
YES
Initials
Does the patient want to continue the detox and willing to engage in support?
Yes No

If “Yes” go to point 3.

If “No” discharge patient with no detox medication and advise to keep drinking at a
steady level. Advise pt to see own G.P. if wishes to detox in future.
3
Complete with patient the “Patient Contract and consent Form” information sheet
(On page 3 of this protocol). Write down the patients Regime on Page 4 (“Your
Medication Regime”) and give this page to the patient.
4
Clinician completes a TTO prescription for the remaining days of detoxification.
On the Hospital’s IDS system select the order set "Medicine- Chlordiazepoxide
discharge regime”. This IDS set will include 7 days of Thiamine 50mg QDS and
Vitamin B Co Strong 2 BD.
5
Fax G.P Letter notifying the management plan upon discharge.
6
Mon – Fri 9-5: Inform Alcohol Liaison Team on Bleep 552 or Tel 6572 to
arrange Outpatient appointment with Alcohol Liaison Nurse.
Out Of Hours: Inform Alcohol Liaison Team (6572) leaving patient’s name and
telephone number and give patient information leaflet.
(N.B. If patient is unwilling to commit to follow up post discharge question patient’s motivation to
stop drinking.)
A Whitfield/J Plumley Feb. 2010
1
ALCOHOL WITHDRAWAL
REGIME
Name………………………………………………..
UR no……….………….……………………………
AFFIX ID LABEL
A TTO can only be dispensed following
completion of Day 3
Day
Chlordiazepoxide
dosage

1
20mg qds (Inpatient)

2
20mg qds (Inpatient)
3
20mg qds (Inpatient)
4
15mg qds
5
10mg qds
6
5mg qds




7
Plus Chlordiazepoxide 20mg PRN, max 140mg daily.
Halve doses for elderly.
If withdrawal symptoms severe or past history of withdrawal fits,
consider higher starting dose e.g. 30mg or 40mg qds and
suitability for community detox
If withdrawal seizures occur, give Diazepam PR or IV
Parenteral B vitamins:
- consider in coma/delirium from alcohol withdrawal
- Pabrinex 2 pairs every 8 hours for 3 days if incipient or
established Wernicke’s*;
1 pair once daily for 3 days if high risk without Wernicke’s*
Thiamine: 50mg qds po
Vitamin B complex: 2 tablets bd po for 10 days
5mg bd
*
PATIENTS AT RISK OF WERNICKE’S INCLUDE those with significant weight loss, poor diet, peripheral
neuropathy, severe withdrawals or past history of severe withdrawals.
*
WERNICKE’S IS CHARACTERISED IN 80% OF CASES BY CONFUSION ONLY - do not wait for full
syndrome i.e. ataxia, opthalmaplegia & confusion
Example
Mr Green is admitted to UHSM following a seizure following abruptly stopping his alcohol
consumption. He does not experience any delirium tremens and is deemed medically fit for
discharge on Day four (March 22nd) of his detoxification on Chlordiazepoxide. The patient wishes
to complete the detox and appears motivated to remain abstinent from alcohol upon discharge.
The clinician needs to write a day by day TTO prescription as follows:
Drug
Dose
Route
Chlordiazepoxide
5mg Capsules
Chlordiazepoxide
5mg Capsules
Chlordiazepoxide
5mg Capsules
Chlordiazepoxide
5mg Capsules
15mg
Oral
10mg
Oral
5mg
Oral
5mg
Oral
Frequency Days
Supply
FOUR
1
times daily
FOUR
1
times daily
FOUR
1
times daily
TWO times
1
daily
GP to
continue
No
Pharmacy
No
No
No
Mr Green’s other medication (including Thiamine and Vitamin B Co Strong) are also written on
the TTO. An Appointment is made to see the Alcohol Liaison Nurse on 23rd March in the
Emergency Department which Mr Green agrees to attend. A G.P. letter is faxed detailing the
treatment plan.
A Whitfield/J Plumley Feb. 2010
2
Tail-End Detoxification Patient
Contract and Consent Form
Name………………………………………………..
UR no……….………….……………………………
Patient to read and sign this form:
AFFIX ID LABEL
1. You (The Patient) agree to complete your detoxification in the community
2. The detoxification procedure has been explained to you
Please tick if you understand the following:
The physical and psychological aspects of alcohol withdrawal, severity,
duration and intensity of symptoms.
The approaches to managing alcohol withdrawal symptoms e.g. good fluid
intake, small regular meals, sleep, hygiene etc.
The pharmacological aspects of detoxification including effects, side effects,
cautions and contradictions of medications used.
The dangers of continuing alcohol use during the detoxification and its
interaction with medication used.
The risks associated with using other drugs of abuse e.g. opiates,
benzodiazepines during withdrawal and during subsequent sobriety.
The importance of continued psychological/ pharmacological interventions to
maintain abstinence from alcohol.
3. You agree to the following conditions:
o You will not drink alcohol during the agreed period of detoxification.
o You will take all medication as prescribed and agreed with you, your doctor and the
Alcohol Team.
o You will make a follow-up appointment with relevant community services to support
you during and after your detoxification to ensure ongoing sobriety.
My appointment is with ___________________________________________
On ______________ At __________________________________________
Signed (patient) _________________________ Date __________________
Signed (Health Care Professional) __________________ Date ___________
A Whitfield/J Plumley Feb. 2010
3
Please write the Librium Prescription
on this page for the patient to take
home with them.
Name………………………………………………..
UR no……….………….……………………………
AFFIX ID LABEL
Standard Tail-End Detoxification Medication Regime
Name of Capsules: Chlordiazepoxide (Librium) 5mg
Day
1
Morning
20mg
Lunch
20mg
Tea
20mg
Bedtime
20mg
2
20mg
20mg
20mg
20mg
3
20mg
20mg
20mg
20mg
4
15mg
15mg
15mg
15mg
5
10mg
10mg
10mg
10mg
6
5mg
5mg
5mg
5mg
7
5mg
Nil
Nil
5mg
Total
74 capsules
Your Medication Regime
Name of Capsules: Chlordiazepoxide (Librium) 5mg
Day/ Date
1(In Hospital)
Morning
Lunch
Tea
Bedtime
2(In Hospital)
3(In Hospital)
4
5
6
7
Total
A Whitfield/J Plumley Feb. 2010
4
Alcohol Liaison Team
Care Facilitator Referral Form
Patient’s name:
D.O.B:
Ethnicity: Date of admission:
Address:
Date of referral:
Gender:
Consent given?
Postcode:
M
Y
F
N
Phone number:
Referral Source (Ward and Name):
Presenting problem:
Expected length of stay:
GP Details:
Please Fax to 6748
A Whitfield/J Plumley Feb. 2010
5