This document is a summarised version of Emergency Department DG-CC4, Provision of Alcohol and Other Drugs (AOD) Care in Western Health Footscray and Sunshine Emergency Departments. The summary has been created to be Emergency Department specific, and has been endorsed by the ED Leadership Team. Staff should review the PPG if they require further information. Alternatively, additional information contained within this PPG has been summarised in the QRG: Mental Health and Alcohol and Other Drugs (MHAOD) Care In Emergency Departments.
This guideline details the specialised services that support effective and safe AOD patient care across Footscray Hospital and Sunshine Hospital Emergency Departments.
This QRG is applicable to all staff working in SHED.
It is the responsibility of the Nurse Unit Managers and Directors of the Emergency Departments of each site to ensure the relevant staff are familiar with this QRG and associated PPGs.
Early identification of AOD care needs and referral to ED AOD services provides the patient with Best Care options and outcomes.
Services supporting AOD care in Footscray Hospital and Sunshine Hospital Emergency Departments include:
AOD Assessments
As a minimum requirement, AOD assessments will include the details listed on the first page of the AOD ED Assessment Form (see Appendix). When deemed appropriate, it will also include completion of a Victorian intake screener assessment +/- comprehensive assessment, such as found at Intake process and tools – health. Vic.
While in ED, patients with AOD care needs may be offered the following harm reduction interventions, education and health promotion:
AOD clinicians can (with patient consent) offer families and support persons educational interventions and provide community AOD family support contact information for self-referral.
Best practice in AOD care is to provide withdrawal management guidance for all patients showing signs of withdrawal or who are at risk of withdrawal.
For all withdrawal interventions, a referral to ED AOD services is required. This includes withdrawal from:
Note that smoking is not allowed in WH premises and all patients should be assessed for nicotine withdrawal. AOD clinicians will provide addiction assistance. All patients should be offered nicotine replacement therapy (NRT) in the form of patches, gum or inhalers.
In the absence of AOD clinician guidance, an ED medical officer can instigate alcohol and/or opioid withdrawal management in accordance with WH procedures OG-GC6 and OP-GC6.
Referrals to ED AOD Services can be made by Medical, Nusing, EMH/ECATT, Pharmacy and ACE staff as required. Referrals will be picked up by AOD CNCs.
Referrals should include at minimum:
| Referral Pathway | Referral Method |
| AOD Clinical Nurse Consultant (while patient remains in ED) |
|
| AOD Clinical Nurse Consultant (for telephone follow-up after patients are discharged)* |
|
| Addiction Medicine Consultation and Liaison Service* |
|
| On-call After Hours Addiction Medicine consultant | Can be contacted by the medical team via switch for consultation and advice. |
*In the absence of on-site AOD CNC cover, patients can be referred to Addiction Medicine C/L via pager (during office hours).
When considering referrals, note that patients with AOD care needs present to the ED with a range of acute AOD-related needs. While some acute presentations are clearly AOD-related, other presentations where AOD use is a contributing factor may require screening to identify the need to refer to AOD services.
The following non-exhaustive list illustrates some of the most common AOD-related ED presentations:
A clinical decision will determine if the patient will be discharged with a supply of medication or a prescription.
Any patient discharged with medications for continuation of withdrawal should have a clear follow-up plan in place detailing a dosing schedule, community follow-up within 48 hours, appropriate adult supervision at home, and safety-netting advice. A limited supply of withdrawal medication should be provided to reduce risk of overdose.
For opioid replacement therapy (ORT), arrangements should be in place for community prescribing and pharmacy dispensing.
Please refer to Supporting Documents for more information on patient discharge:
All contacts with patients with AOD care needs by all clinicians are to be recorded in EDIS. In addition, it is current practice that nurses record contacts on the nursing bedside chart.
For patients who are going to be admitted to community AOD bed-based services, AOD clinicians must copy and paste their notes into the EMR.
| Title: | Services Supporting Alcohol and Other Drugs (AOD) Care in Emergency Departments | |
| Version: | 1.0 | |
| Date Published: | May 2022 | |
| Date of scheduled review: | May 2024 | |
| Author: | Approver: | |
| ED Leadership Team | ED Leadership Team | |
