Setting

This audit may be particularly relevant to liaison psychiatry services involved in the management of patients with alcohol dependency in the general hospital setting. It may also be relevant to mental health in-patient units managing patients in alcohol withdrawal.

Background

Poorly managed alcohol detoxification can cause distress to individuals and their carers, and increase referral rates to liaison psychiatry services. Individuals who have undergone inadequate detoxification are less likely to engage in subsequent alcohol rehabilitation. Thiamine deficiency secondary to alcohol dependency can lead to permanent neurological damage such as Wernicke–Korsakoff syndrome. Appropriate alcohol detoxification and vitamin prophylaxis are crucial in preventing these problems.

Standards

Standards were obtained from guidelines for the pharmacological management of alcohol withdrawal published by the Royal College of Physicians (2001) and the British Association for Psychopharmacology (Lingford-Hughes et al, 2004). The hospital guidelines derived from these documents are detailed in Appendix 2 to this book.

1. ▸ For alcohol detoxification, prescriptions were judged to meet the standard if either chlordiazepoxide or diazepam was prescribed as a reducing regimen for an adequate duration.

2. ▸ For vitamin prophylaxis, prescriptions met the standard if the dose, route and duration were in accordance with the guidelines.

Method

Data collection

For the duration of the audit, members of the general hospital liaison psychiatry team visited the acute admission wards daily to identify patients who had been prescribed an alcohol detoxification regime by the admitting medical or surgical team. Ward staff and hospital pharmacists cooperated in identifying such patients. Individual patients’ prescription charts were assessed against the standards. In the first audit cycle, 27 prescription charts were scrutinised. Following a period of intervention, a second audit cycle scrutinised a further 22 prescription charts.

Data analysis

For each audit cycle, the percentage of charts where the prescription was judged to be in accordance with the guidelines was calculated for:

1. ▸ alcohol detoxification

2. ▸ vitamin prophylaxis.

Resources required

People

It is suggested that this audit is undertaken by at least two people, owing to the amount of information collected and the possible need to confer over cases where the adequacy of the prescription is unclear.

Time

For one audit cycle scrutinising 20–25 prescription charts, it is estimated that the data collection would take 15 hours.