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Alcohol-use disorders:
physical complications
Implementing NICE guidance
2nd. Edition – August 2011
NICE clinical guideline 100
Directly related NICE guidance
This guideline is one of three pieces of NICE
guidance addressing alcohol-use disorders. The
others are:
• Preventing hazardous and harmful drinking
(PH24)
• Dependence and harmful alcohol use (CG115)
The term alcohol-use disorders encompasses
physical, mental and behavioural conditions
associated with alcohol use.
NICE Pathway
The NICE Alcohol pathway shows recommendations on:
• key areas in the investigation and management of alcohol-related
physical complications.
• the diagnosis, assessment and management of harmful drinking
and alcohol dependence
• prevention and early identification of alcohol-use disorders,
including interventions in schools to prevent and reduce alcohol use
among children and young people
Click here to go to
NICE Pathways
website
What this presentation covers
Background
Scope
Recommendations
Costs and savings
Discussion
NHS Evidence
Find out more
NICE alcohol quality standard
Background
• In the UK, it is estimated that 24% of adults drink in a
hazardous or harmful way.
• Continued hazardous and harmful drinking can result in
alcohol dependence and damage to almost every
organ or system of the body.
• This clinical guideline aims to ensure that patients with
alcohol-related complications receive the best possible
clinical care.
Scope
This guideline covers key areas in the investigation and
management of alcohol-related physical complications in
adults and young people (10 years and older) as follows:
•
•
•
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acute alcohol withdrawal
Wernicke’s encephalopathy
liver damage
acute and chronic pancreatitis.
It does not specifically look at:
•
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women who are pregnant
children younger than 10 years
people with physical or mental health conditions
caused by alcohol use, other than
those listed above.
Definitions
Acute alcohol withdrawal
Alcohol dependence
Coeliac axis block
Decompensated liver disease
Harmful drinking
Hazardous drinking
Medically assisted alcohol withdrawal
Medicines licensing
Recommendations
Key themes for recommendations:
• Acute alcohol withdrawal
• Delirium tremens, alcohol withdrawal seizures and
Wernicke’s encephalopathy
• Alcohol-related liver disease
• Alcohol-related pancreatitis
Acute alcohol withdrawal: 1
For people in acute alcohol withdrawal with, or
who are assessed to be at high risk of
developing, alcohol withdrawal seizures or
delirium tremens, offer admission to hospital for
medically assisted alcohol withdrawal.
Acute alcohol withdrawal: 2
Healthcare professionals who care for people in
acute alcohol withdrawal should be skilled in the
assessment and monitoring of withdrawal
symptoms and signs.
Acute alcohol withdrawal: 3
Follow a symptom-triggered regimen for drug
treatment for people in acute alcohol withdrawal who
are:
• in hospital
or
• in other settings where 24-hour assessment and
monitoring are available.
Specific circumstances: 1
• Delirium tremens
Offer lorazepam* or alternative
Review withdrawal drug regimen
• Alcohol withdrawal seizures
Offer a quick-acting benzodiazepine
Do not offer phenytoin
Review withdrawal drug regimen
Specific circumstances: 2
• Wernicke’s encephalopathy
Offer thiamine (oral and/or parenteral) to
people at high risk of developing, or with
suspected, Wernicke’s encephalopathy.
Alcohol-related liver disease
Refer patients with decompensated liver disease to be
considered for assessment for liver transplantation if
they:
• still have decompensated liver disease after best
management and 3 months’ abstinence from alcohol
and
• are otherwise suitable candidates for liver
transplantation.
Alcohol-related pancreatitis
Refer people with pain from chronic alcohol-related
pancreatitis to a specialist centre for multidisciplinary
assessment.
Supporting QIPP
Symptom-triggered dosing for the inpatient management
of acute alcohol withdrawal is likely to reduce the
patients length of stay.
Do not offer phenytoin to treat alcohol withdrawal
seizures.
Do not give prophylactic antibiotics to people with mild
acute alcohol-related pancreatitis, unless otherwise
indicated.
Do not prescribe pancreatic enzyme supplements to
people with chronic alcohol-related pancreatitis
if pain is their only symptom.
Costs and savings
per 250,000 population
Recommendations with significant costs
Costs (£ per year)
Assessment and monitoring of people in acute
alcohol withdrawal [1.1.2]
50,448
Pancreatic surgery versus endoscopic therapy for
chronic alcohol-related pancreatitis [1.4.2]
4,764
Estimated cost of implementation
55,212
Recommendations with significant savings
Savings
(£ per year)
Follow a symptom-triggered regimen for drug
treatment for people in acute alcohol withdrawal
[1.1.3.4]
35,185
Estimated saving of implementation
35,185
Costs correct at June 2010.
Costs not updated for 2nd. edition
Discussion
• How can we move from fixed dosing to symptomtriggered treatment? How will the additional patient
monitoring be done? What staff training needs are
there to deliver this recommendation?
• How will these recommendations affect the attainment
of A&E targets? What can be done to ensure we
continue to meet A&E targets?
• Is there a role for specialist alcohol liaison workers or a
specialist doctor or nurse who is available 24 hours a
day? Do we have these in our organisation? If
so how can we use them?
NHS Evidence
Visit NHS Evidence for
the best available
evidence on all
aspects of harmful
alcohol use
Click here to go to
the NHS Evidence
website
Find out more
Visit www.nice.org.uk/guidance/CG100 for:
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•
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the guideline
the quick reference guide
‘Understanding NICE guidance’
costing report and template
audit support
baseline assessment tool
NICE Quality Standard
Alcohol dependence and harmful
alcohol use
August 2011
Quality Standards
A quality standard is a set of specific, concise
statements that:
• act as markers of high-quality, cost-effective patient
care across a pathway or clinical area, covering
treatment and prevention
• are derived from the best available evidence such
as NICE guidance or other NHS evidence
accredited sources
• are produced collaboratively with the NHS and
social care, along with their partners
and service users
Alcohol Quality Standard
• This Quality Standard covers the care of people aged
10 years and over with alcohol dependence and
people drinking in a harmful way in all NHS and social
care-funded settings
• It also includes identification and brief interventions
for hazardous drinkers
• The Quality Standard consists of 13 quality
statements.
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