Enhancing the effectiveness of community drug and alcohol teams working with opioid-dependent pregnant women: results of an audit

Mani Sairam,Rakesh Magon,Christos Kouimtsidis

doi:10.1192/pb.bp.111.038166

Mani Sairam, Rakesh Magon + Show 1 more

Open Access

https://doi.org/10.1192/pb.bp.111.038166

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Abstract

Aims and methodTo evaluate the quality of services offered by community drug and alcohol teams (CDATs) to pregnant women in substitution treatment. A full audit of the practice across all local CDATs against national standards was undertaken in 2008 and 2010.ResultsQuality of services improved and met three standards in 100% and the fourth standard in 96% of cases. There was good implementation of the recommendations arising out of the action plan of the first cycle, which resulted in significant improvements in interagency liaison and risk-benefit analysis documentation within the CDATs.Clinical implicationsManagement of pregnant women in substitution treatment can be improved by adhering to a multipronged approach as identified by this audit.

Highlights

There was good implementation of the recommendations arising out of the action plan of the first cycle, which resulted in significant improvements in interagency liaison and risk-benefit analysis documentation within the community drug and alcohol teams (CDATs)
A retrospective case-note review was conducted of all female clients referred or attending community drug and alcohol teams (CDATs) in Hertfordshire in the calendar year 2008
Pregnant women were identified by professionals within each CDAT

Summary

Results

21 women were identified. All but 1 used opioids, either alone (6 women) or with other drugs (14 women) and they were on substitute prescribing. All treatment plans were agreed with the woman and reflected her choice. The treatment aim for 12 women was detoxification and for 8 it was stability (first standard). Liaison with other services (general practitioner and midwife/antenatal services) has been documented in 19 cases (90%, third standard). Documentation of risk-benefit analysis existed in 14 cases (67%, fourth standard). The significant gaps in the interagency liaison and risk-benefit analysis have generated six recommendations, which were agreed in clinical governance and were implemented in all CDATs (Table 1). In contrast with the sample in the first cycle, only two women were new to the services. Treatment preference for stability or detoxification, time of detoxification and liaison with other services met national standards in all cases. Obtaining consent for liaison with other services was implemented only in 68%, liaison has taken place in all cases. The required assertive management was reflected in 84% of care plans (Table 1)

Method

Discussion