8.1 Local implementation

Implementation of national clinical guidelines is the responsibility of local NHS organisations and is an essential part of clinical governance. It is acknowledged that not every guideline can be implemented immediately on publication, but mechanisms should be in place to ensure that the care provided is reviewed against the guideline recommendations and the reasons for any differences assessed and, where appropriate, addressed.

hese discussions should involve both clinical staff and management. Local arrangements may then be made to implement the national guideline in individual hospitals, units and practices, and to monitor compliance. This may be done by a variety of means including patient-specific reminders, continuing education and training, and clinical audit.

8.2 Key points for audit

• Are primary care workers opportunistically identifying people with an alcohol problem and delivering appropriate brief interventions?
• At new patient registration in general practice, what is the proportion of completed sections on alcohol consumption?
• Are staff delivering treatments such as motivational interviewing according to recognised methodology?
• Are there local protocols for alcohol withdrawal management in place and in use?
• Does the practice have access to a breathalyser?

A brief instrument which has been used in audit of outcomes is the Alcohol Related Problems Questionnaire.¹⁵⁵

8.3 Recommendations for research

Further high quality research in a representative population group is needed to:

• establish the effectiveness of routine brief intervention in the A&E setting
• compare outcomes for in/outpatient detoxification
• study the use of oral vitamin preparations in primary care, and whether subsequent Wernicke-Korsakov syndrome, neuropathy or cerebellar damage is delayed/prevented
• appraise alcohol policy initiatives in order to ascertain the cost effectiveness of such treatments,and of “brief interventions”
• simplify screening tools
• study the efficacy of alternative therapies in treating patients with an alcohol problem.