Close Search
Open Menu Close Menu Open search

Services Supporting Alcohol and Other Drugs (AOD) Care in Emergency Departments

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.

Overview

This guideline details the specialised services that support effective and safe AOD patient care across Footscray Hospital and Sunshine Hospital Emergency Departments.

Applicability

This QRG is applicable to all staff working in SHED.

Responsibility

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.

Guideline/Process Details

Specialised Alcohol and Other Drugs Teams

Early identification of AOD care needs and referral to ED AOD services provides the patient with Best Care options and outcomes.

  • All patients of all ages presenting with AOD care needs should be referred to ED AOD services.
  • All patients should be assessed for Nicotine Withdrawal and referral to ED AOD Services.

AOD Services in EDs

Services supporting AOD care in Footscray Hospital and Sunshine Hospital Emergency Departments include:

  • Assessment;
  • Secondary consultation (i.e. guidance for ED clinicians such as advice on treatment plans and withdrawal management);
  • Harm reduction, education and health promotion;
  • Brief interventions and motivational interviewing;
  • Withdrawal management including initiation of pharmacotherapy, opioid replacement therapy (ORT) and nicotine replacement therapy (NRT);
  • Referral into community AOD services; and
  • Family support for carers and family members of patients with AOD care needs.

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.

  • Nursing and medical staff are encouraged to be familiar with the Assessment Form to support making referrals to ED AOD services.
  • Nursing staff should continue current practice of documenting AOD care needs on the observation chart where appropriate.

AOD Interventions

While in ED, patients with AOD care needs may be offered the following harm reduction interventions, education and health promotion:

  • Structured brief intervention, including motivational interviewing (exploring ambivalence related to substance use and eliciting change talk)
  • Opioid overdose education and the provision of take-home naloxone
  • Provision of educational resources and community AOD service contact information (for self-referral)
  • Blood borne virus (BBV) screening
  • Education related to:
  • GHB and/or stimulant overdose
  • Alcohol dependence
  • Drug withdrawal
  • Safer injecting
  • Impact of AOD use on mental and physical health
  • Alcohol-related harms
  • Polysubstance use (the risks of mixing drugs and drug interactions)

AOD clinicians can (with patient consent) offer families and support persons educational interventions and provide community AOD family support contact information for self-referral.

Withdrawal Management

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:

  • Alcohol
  • Opioids
  • GHB
  • Cannabis
  • Amphetamine-type stimulants (methamphetamine, amphetamine, MDMA) and cocaine
  • Benzodiazepines
  • Nicotine

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.

Referral for ED AOD Services

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:

  • Patient UR and name.
  • AOD care needs the patient is presenting with today; including:
    • current AOD use history; and
    • signs of withdrawal and/or a withdrawal risk
Referral Pathway Referral Method
AOD Clinical Nurse Consultant (while patient remains in ED)
  • Phone call (when clinicians are on-site);
    • Phone (834)51913 at Sunshine Hospital
  • Face-to-face visit to AOD office or in ED; or
  • EDIS consultation request.
AOD Clinical Nurse Consultant (for telephone follow-up after patients are discharged)*
  • Email AODSHED@wh.org.au
  • Note: Patients must have consented to this follow up contact.
Addiction Medicine Consultation and Liaison Service*
  • Pager #5017 at Sunshine Hospital.
  • Pager #544 at Footscray Hospital.
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:

  • Acute alcohol or other drug (illicit or prescription) intoxication, withdrawal or overdose
  • Medical complications of alcohol or other drug use, such as liver disease, pancreatitis, hepatitis, gastro-oesophageal reflux disease, skin and soft tissue infections secondary to injecting drug use, falls, accidents, injuries and seizures
  • Psychiatric complications of alcohol or drug use, including psychotic disorders, mood disorders, mental state deterioration and sleep disturbances
  • Social harms from alcohol or drug use, including homelessness and family violence

Discharge Medication

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:

Documenting AOD Patient Care

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.

Appendix – AOD ED Assessment Form

Supporting Documents

Policy, Procedure and Guidelines (PPGs)

QRGs

Document Governance

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

 

Print this Page