Measuring the units

Published: 08 October 2013

Lynda Greenslade, Clinical Nurse Specialist in Hepatology, Royal Free Hospital, London reviews the NCEPOD report released in June 2013 on deaths from alcohol-related liver disease (ARLD).

The report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Alcohol-related liver disease (ARLD): measuring the units, has made for difficult reading and has raised many issues for nurses caring for this group of individuals. Many of these individuals are cared for across a spectrum of services both in primary and secondary care, and as such this report is pertinent to the vast majority of nurses whatever their clinical background, as alcohol abuse is becoming much more widespread.

The report sets out that the majority of patients who died were young, with an average age of 59. It looked back at their care and highlighted a number of themes:
• missed opportunities to refer to alcohol support services
• the severity of the patient’s illness was not identified
• patients referred to outpatients when an inpatient admission would have been more appropriate
• direct referral to specialist services would have been more appropriate
• in some cases, a palliative care referral could have prevented the final admission as the patient was continuing to deteriorate despite appropriate treatment.

Patients with ARLD can be complex and difficult to manage but when they deteriorate they can become acutely unwell quickly and need specialist input. This is not always recognised in a timely manner and delays occur in treating this young cohort of patients. One of the reasons may be the stigma of this condition, and some health care professionals will reflect the views of our wider society in relation to this.

Many patients with ARLD, if supported to stop drinking, can see huge improvements in their liver function and resolution of their complications. As nurses we need to champion these patients, wherever they present, to make sure they receive high-quality care by the right team, in the right place, at the right time.