patient case studies - drink talking
TRANSCRIPT
Patient Case Studies
Substance Misuse Specialist NurseWirral University Teaching Hospital
Ann Taylor
KKI/UKIRE/PAB/0226 September 2020
Prescribing information is available either at the meeting where these slides are presented or available online in the link below this presentation
This presentation is commissioned and funded by Kyowa Kirin
Patient Case Study 1
Male 53yrs oldDivorced
Has 5 children still has some contact with them although sporadic
Rough sleeping and sofa surfing
Unemployed on benefits
Estranged from parents and siblings
Patient History• Patient known to community services in the past• Previous IVDU opiate addiction nil for several years• Drinking for past 10-12 years to excess• Not engaging with any services• Admitted in withdrawal • Wide gait, poor memory, unkempt• Street homeless
Patient History• Multiple admissions• Falls• Head Injury• Intoxication• Assaults• Known alcohol excess• Several previous hospital detoxes• Memory problems• Not engaging with community alcohol services
Patient SituationReferral to Alcohol Related Brain Damage (ARBD) Team
Direct from hospital Cerner System
Criteria • Alcohol intake >35units per week for 5 years• 3 or more presentations in last year• One or more delayed discharges• Confusion, memory problems, doubt about capacity, concerns
about risk
Actions and Outcome• Seen with mental health worker who noted patient had poverty of
thought• 6CIT completed patient scored over 8• Met criteria for referral to ARBD Team• Patient reviewed by ARBD Nurse and formally assessed by Professor
Wilson• Patient on DoLS as lacks capacity• Transferred to a ARBD mental health nursing home for treatment
Follow up• Patient care transferred to a nursing home• Community ARBD continued care in the care home• 6 months later patient discharge to own accommodation• Continues to improve• Patient how volunteers for ARBD services• Lives completely independently • Has reconnected to his family• He remains alcohol free
Patient Case Study 2
Male 46yrs oldSingle
Known insulin dependent diabetic
Street homeless and night shelter
Unemployed on benefits
NOK sister lived in Liverpool no contact for quite a while
Patient History• Patient known to community services although poor attendance • Not managing his insulin and when he is on the streets does not take insulin as
nowhere to store this• Drinking to excess for many years• Uses heroin sporadically referred to service for methadone does not collect this
from the pharmacy• Difficulties engaging him with services, outreach team try to keep contact• Admitted due to diabetes went into withdrawal on admission• Wide gait, poor memory, unkempt inappropriate behaviour and language• Burnt down his flat waiting to see if he will be charged with arson• Currently staying in a hostel spends lots of nights on the street
Patient History• Multiple admissions• Falls• Unstable diabetes• Head Injury• Intoxication• Assaults• Memory problems• Inappropriate behaviour and language• Not engaging with community alcohol services
Patient SituationReferral to Alcohol Related Brain Damage (ARBD) Team
Direct from hospital Cerner System
Criteria • Alcohol intake >35units per week for 5 years• 3 or more presentations in last year• One or more delayed discharges• Confusion, memory problems, doubt about capacity, concerns
about risk
Actions and Outcome• Seen by Substance Misuse nurse well known to the Team• 6CIT completed patient scored over 8• Met criteria for referral to ARBD Team• Patient reviewed by ARBD Nurse and formally assessed by Professor
Wilson• Patient on DoLS as lacks capacity• Transferred to a ARBD mental health nursing home for treatment
Follow up• Patient care transferred to a nursing home• Community ARBD continued care in the care home• Patient continued to deteriorate physically and mentally while in
care• Assessed for long term nursing care• In the nursing home for almost a year• Sadly passed away on New Years day 2020
Key Learnings• Importance the role of Pabrinex® (high potency vitamins B and C) plays in
protecting the brain and preventing ARBD• Importance of managing physical health problems with a chaotic patient • Using tools 6CIT and Moca to inform diagnosis• Importance of distinguishing between intoxication and poor cognition• Being aware of the signs and symptoms of ARBD• Having a robust pathway of care to the most appropriate services