QAAD

QAADNET Meeting Report 27th Feb, 2010

At this meeting we were delighted to welcome Professor Robin Touquet and Lianna Pim as our speakers.

Robin shared with us his perspectives as a consultant at St Mary’s Hospital Paddington, where he is Professor of Emergency Medicine. He described a system of help for patients who present with alcohol-related conditions. Read more (then click to my article in the new QAADRANT, and also David Barry’s).

Lianna Pim discussed her alcohol education film ‘Too Much Too Young’, which was made with the support of QAAD and Sibford School.

ALCOHOL: HELPFUL APPROACHES

At this meeting we were delighted to welcome Professor Robin Touquet and Lianna Pim as our speakers.  David Barry of Hasting Quaker Meeting describes the gathering:

REASONS FOR HOPE

Years ago my ex-wife and I, who were avid theatre goers, always judged how good an evening had been by the length of time it took for our conversation to go from the evening’s performance to the more mundane domestic chat. We rarely reached home before discussing who should be doing the washing up. Using the same yardstick the Qaadnet meeting was superb. 24 hours later I am still mulling over the words and thoughts of our two speakers.

The morning was taken up with a talk by Robin Touquet. When I met Robin – taking on board his description of himself as having a military gait & booming voice that seemed more suited to an army parade ground – I felt he would be the last person to see alcohol addiction as an illness and not simply a weakness. How wrong I was.

He started by telling us of his work in Emergency Department at St. Mary’s Hospital, London. He obviously has worked at the sharp end of the results of over-indulgence in alcohol. He immediately allayed my fears by saying that these drinkers are sick and need to be treated as such by the medical profession. His view of heavy drinkers being sick was repeated several times during his talk. I wondered if this stemmed from years of having to convince colleagues that A&E needs to do more than patch the injured up and send them on their way.

His talk was not over dependent on statistics, and he spoke of it being “A

story of hope.” His way of addressing the alcohol problem, rather than the results of it, was a refreshing and encouraging change to the traditional Accident and Emergency Department. He highlighted the problems of young people binge drinking, and vastly increasing their chances of becoming alcohol dependent. He went on to point out that those under the influence are far more likely to be mugging victims and that he had never seen a case of date rape where alcohol was not involved.

Robin ended, rather later than planned due to his willingness to answer the deluge of questions being put to him, by saying he is one of life’s enthusiasts. The lunch break was spent with most of the 30 odd attenders discussing Robin’s talk having been enthused by his passion for his work.

The afternoon session started with Lianna Pim showing us the 11 minute film ‘Too Much Too Young’ she had created. It was aimed at teenagers to demonstrate the dangers of alcohol. I found the film very moving. My immediate response was to say that it should be compulsory viewing in secondary schools. It was hard hitting and to the point, but without being sensationalised. Lianna was quietly spoken as well as modest about her achievement. She explained how this had been done for use by QAAD and as part of an “A” level project for media studies. She expressed a hope that it would be seen by as many young people as possible. I echo that thought.

As I walk around the town of Hastings, near my home, and see the number of young people with their cans of beer, sipping as they walk aimlessly around, the numbers of young parents sitting drinking outside pubs with babies sleeping in buggies, and read in local papers of people being processed through the courts for drink and drug related offences, I sometimes despair. I would love to tell these people how alcohol crept up and took over nearly 30 years of my life. Listening to Robin and Lianna I am reassured that the £800 million drinks companies spend on promotion is being quietly countered, and will not destroy as many lives as it could otherwise. Society

Taking Hope Forward: the Importance of Alcohol Nurse Specialists

Helena Chambers discusses Robin Touquet’s work as Professor of Emergency Medicine at St Mary’s Hospital, Paddington

Robin Touquet described a system of working that he instigated in 1988 out of frustration of lack of services for those brought in drunk. Between 12% and 70% of patients presenting at Emergency Departments have been drinking – the latter figure most likely on a Saturday night – but detection and the giving (or not) of appropriate ‘Brief Advice’ has always been the problem. Robin’s investigations and studies have established that the ten ways in which in which alcohol misuse is most likely to present to Emergency Departments are: fall, collapse, head injury, assault, accident, feeling unwell, gastro-intestinal, cardiac and psychiatric conditions (especially self-harm) and repeat attendance.

In response to this data, he and his team devised a clinical tool to correlate attendance with drinking – known as the Paddington Alcohol Test (PAT). It helps both staff and the patient understand the role of alcohol played in the presenting medical condition, and offers a prompt and sympathetic response

Just 1-2 minutes (the ‘The Teachable Moment’) with any doctor or nurse who relates the patient’s drinking to hospital attendance, coupled with the offer of 20 – 30 minutes from an Alcohol Nurse Specialist has been shown to be effective in reducing consumption over six to twelve months. For every two accepted appointments with the Alcohol Nurse Specialist there is one less re-attendance over twelve months. The service thus addresses the emergency, but also works preventatively.

Responses need to be quick; the half-life of the ‘Teachable Moment’ – the opportunity taken to encourage a patient to contemplate change – has been shown to be 48 hours. Hence the worth of every acute hospital having ANSs as integrated staff. These staff are also trained to respond to the specific medical difficulties related to severe or chronic alcohol consumption.

Robin spoke of the importance of establishing and maintaining a system where Alcohol Nurse Specialists are part of every Emergency Department, so that all those in need can be helped. At a time when cuts are possible, preserving such services, which prevent as well as cure, is vital. QAAD is grateful to Robin for sharing his experience and the information on which this article is based. It will inform our public issues work .