Nurse led care in addictions; early identification of Wernicke-Korsakov in alcohol drinking populations in primary care.

Background:

Much research has been conducted in the addictions field in recent years, particularly on the roles and responsibilities of different levels of nursing. In addiction care, there has been a great deal of research into nurse-led care in addiction services. Outcome are in facilities where MANP Addictions in clinical lead care interventions lead to good patient-related outcomes. Reduced absenteeism, satisfied staff, improved patient-related routine outcome measures, increased patient satisfaction and, finally, care has become cheaper due to improved use of professionals. In collaboration with IntNSA Holland nurse specialists (MANP) have initiated innovations aimed at nurse-led care for addicted patients. The early detection of Wernicke-Korsakov syndrome in alcohol-using patients in primary care was initiated, developed and implemented/evaluated by MANP nurses. The workshop will focus on the background, implementation and outcomes at patient and staff level.

Method

Implementation of a collaboration model in primary health care

Wernicke-Korsakoff syndrome (WKS) is a severe neuropsychiatric syndrome, a consequence of chronic alcohol use disorder (AUD). Early symptoms are poorly recognised by professionals in primary health care settings. WKS is caused by direct alcohol intoxication and vitamin B1 (thiamine) deficiency. It is estimated that approximately 50% of patients with alcohol use disorder AUD have neurocognitive impairment. In particular reduced insight into the illness mean that patients often have difficulty completing self-report questionnaires. 10% have severe cognitive impairment. The current situation needs to be assessed in the context of existing pre-morbid cognitive disorders, personality characteristics, educational level and employment history. 

Results

In practice, a method has been developed to obtain more reliable information. The information provided by patients may differ from that seen/given by family members and practitioners. The Dysexecutive Questionnaire (DEX) and the Patient Competency Rating Scale are used. Once completed, the Q8 items are assessed for appropriateness by a clinician who knows the patient well. 

From the expertise WKS centre nurse specialists developed a collaboration with primary care, sharing knowledge and skills and developing a toolkit to make the screening as complete as possible and the project started in 2023. 

Target group is the heavy drinking patient. Goals include relieving the burden on GP and making referring easier. The workshop will share initial findings, in particular the nature and scope of the first early screening.

References

Fiore-Lopes N., & Shea-Lewis A. (2020) Nurse-Led Initiative to improve Addiction Services. An Interdisciplinary Approach, 192-197.

Arts N., Walvoort S. & Kessel, R. (2017) Korsakoff's syndrome: a critical review,  Neuropsychiatry Dis Treat, 27,13, 2875-2890.