Policies and Procedures

1. Admission Policy

1.1 Eligibility Criteria

Clients may be admitted to the home alcohol detox service if they meet all of the following criteria:

Age: 18 years or older

Diagnosis: Diagnosed with Alcohol Use Disorder (AUD) by a qualified healthcare professional

Clinical Suitability: No history or current risk of severe withdrawal complications, including:

Alcohol withdrawal seizures

Delirium Tremens (DTs)

Active suicidality or severe psychiatric instability

Medical Stability: Assessed as medically stable for at-home detox by a physician, nurse practitioner, or responsible clinician

Consent & Capacity: Client must have:

Full mental capacity to engage in care

Provided informed and voluntary consent for the detox process

Agreed to the service terms and signed the service contract

Clients who do not meet eligibility criteria will be referred to appropriate higher-level care, including inpatient detox or hospital-based services.

1.2 Pre-Admission Assessment

Before admission, the following assessments and checks must be completed and documented:

Comprehensive Nursing Assessment
Includes alcohol history, risk factors, physical health status, mental state evaluation, and social support

Medical Clearance
Written clearance from a licensed GP, psychiatrist, or nurse prescriber confirming medical suitability for community-based detox

Medication & Comorbidity Review
Evaluation of all prescribed and over-the-counter medications, plus management plan for any co-occurring health conditions (e.g., diabetes, hypertension, liver disease)

Home Environment Safety Check
Assessment of the home setting for:

Access to emergency services

Supportive persons on-site (if applicable)

Safe storage for detox medications

No immediate safeguarding concerns

Informed Consent & Service Agreement
Client (and family, if appropriate) must:
- Review all risks and benefits
- Sign a written informed consent form
- Sign a service agreement outlining expectations, rights, and responsibilities

2. Consent & Legal Documentation

All clients must complete and sign the following documentation prior to the commencement of detox treatment, to ensure legal compliance, informed participation, and safe delivery of care:

2.1 Informed Consent for Detox Treatment

The client must sign a written informed consent form confirming:

They understand the nature, purpose, risks, and potential side effects of alcohol detox

They accept the plan of care and agree to adhere to prescribed treatment and monitoring

They are participating voluntarily and retain the right to withdraw consent at any time

2.2 Consent for Emergency Intervention or Transport

The client must give prior written consent for:

Emergency medical intervention if a serious complication arises

Emergency transport to hospital or other urgent care facilities if medically necessary

In cases where the client lacks capacity at the time of an emergency, action may be taken under the Mental Capacity Act 2005, in the client's best interests

2.3 Confidentiality Agreement (Data Protection)

Clients must sign a confidentiality agreement that outlines:

How personal and health information will be collected, stored, and shared

Their rights under the UK GDPR and Data Protection Act 2018

The limits of confidentiality (e.g. safeguarding risks, emergencies)

2.4 Service Contract and Financial Agreement

The client will be provided with a written service agreement covering:

Scope of detox services to be provided

Duration and setting of care

Financial terms, payment schedule, refund policy, and cancellation terms

Client rights, responsibilities, and complaints procedure

2.5 Emergency Contact or Power of Attorney

An emergency contact must be provided in all cases

If a lasting power of attorney (POA) is in place for health and welfare decisions, a copy should be kept on file

Where appropriate, families or legal representatives may be consulted in planning or emergencies (with client consent)

3. Detox Protocol

The home alcohol detox programme is delivered under strict clinical supervision, with protocols in place to ensure client safety, dignity, and comfort throughout withdrawal. This section outlines both clinical oversight and nursing responsibilities during detox.

3.1 Clinical Oversight

Medical Approval
All detox plans must be individually authorised by a registered medical doctor (MD) or nurse prescriber (NP) following a pre-admission assessment.

Withdrawal Monitoring Tool
The Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA-Ar) will be used to:

Objectively assess withdrawal symptoms

Guide medication dosing and escalation

Determine when medical escalation is required

Medication Administration
Medication is prescribed and administered according to established detox protocols, which may include:

Benzodiazepines (e.g. chlordiazepoxide or diazepam) for withdrawal management

Thiamine (oral or IM) to prevent Wernicke’s encephalopathy

Anti-nausea agents, antidiarrheals, or sleep aids as clinically indicated

Vital Sign Monitoring

Every 2–4 hours during the first 48 hours

Frequency adjusted based on:

CIWA-Ar score

Client’s comorbidities

Risk of complications

Monitored signs include:

Blood pressure, heart rate, respiratory rate

Temperature

Mental status

3.2 Nursing Interventions

Registered nurses or trained detox support staff will deliver frontline care with a focus on safety, comfort, and reassurance.

Clinical Monitoring

Observe for:

Escalating withdrawal symptoms (CIWA-Ar score ≥20)

Signs of delirium, hallucinations, seizures

Cardiac symptoms (e.g. chest pain, arrhythmia)

Dehydration, confusion, agitation, or falls

Supportive Care

Encourage and assist with:

Oral hydration and electrolyte intake

Light, nutritious meals as tolerated

Hygiene and toileting support, respecting privacy and dignity

Medication Management

Administer all medications per prescription and protocol

Record:

Drug name, dosage, time, route

Effect and any adverse reactions

Ensure secure medication storage in the home

Emotional & Psychological Support

Provide ongoing emotional reassurance

Use calm, non-judgmental communication

Monitor for low mood, anxiety, or suicidal ideation and escalate appropriately

Client Dignity & Safety

Maintain a respectful, calm, and non-clinical environment

Ensure the client’s right to privacy, autonomy, and informed choices

Conduct all interactions with empathy, discretion, and professionalism

4. Emergency Procedures

Ensuring the safety and well-being of clients during home alcohol detox is paramount. The following emergency protocols outline actions to be taken in the event of medical or psychiatric crises.

4.1 Medical Emergencies

A medical emergency is defined as any situation where the client’s physical condition becomes unstable, poses an immediate risk to life, or exceeds the safe scope of home-based care.

Immediate Action Triggers:

CIWA-Ar score exceeds safe threshold (typically >20–25), indicating severe withdrawal

Signs of seizure activity, loss of consciousness, chest pain, or laboured breathing

Vital signs fall outside safe parameters (e.g. SBP <90 mmHg, HR >120, temp >38.5°C)

Worsening confusion or suspected Wernicke’s encephalopathy

Response Procedure:

Call emergency services (999) without delay
Stabilise the client as able while awaiting EMS (e.g. ensure open airway, recovery position)
Contact the overseeing clinician (MD/NP) for immediate notification
Inform the client’s emergency contact as per consent agreement
Complete full incident documentation, including:
- Time of onset and action taken
- Medications administered
- Communications made (EMS, GP, family)
- Clinical observations leading up to the incident

4.2 Crisis Management (Psychiatric or Behavioural)

Psychiatric emergencies may involve mental health deterioration, aggression, or behavioural disturbances that pose a risk to the client or others.

Common Crisis Scenarios:

Suicidal ideation or intent
Psychosis or hallucinations
Violent or threatening behaviour
Extreme agitation or confusion

Response Procedure:

Attempt de-escalation using:

Calm verbal reassurance
Clear, non-confrontational communication
Removing potential stressors from the environment
If risk persists or escalates:
Contact emergency mental health services (e.g. NHS Crisis Line or 999 if urgent)
Remove others from the environment, if necessary
Inform the supervising clinician
Contact the emergency contact or LPA, if appropriate and safe
Document the incident in full, including:
Behaviour observed
Verbal statements made by the client
Interventions attempted
Services contacted and outcome

Safeguarding and Duty of Care

All staff have a duty of care to act if there is concern for:

The client’s immediate safety

The safety of others in the home

Any safeguarding concerns, including neglect, abuse, or exploitation

5. Documentation & Recordkeeping

Accurate, timely, and secure documentation is essential for safe client care, regulatory compliance, and effective communication within the care team. All records must be maintained in accordance with UK legal requirements, NMC Code of Practice, and Data Protection legislation.

5.1 Required Clinical Documentation

Staff must complete and maintain the following records for each client receiving detox services:

Daily Nursing Notes must be completed each shift or visit and include:

Vital signs (blood pressure, pulse, temperature, respiration rate)

CIWA-Ar scores and observed withdrawal symptoms

Medications given, dose, time, route, and response

Client's physical and emotional status

Any changes in condition or escalation actions

Interactions with family or support persons (if relevant)

Medication Administration Records (MARs)

Clearly document all medications prescribed and administered during detox Include:

Drug name, dosage, route, date/time of administration

Initials/signature of administering nurse

Client's response or any side effects

MARs must be signed and reviewed daily for accuracy

Incident Reports

Must be completed promptly for:

Medical emergencies or hospital transfers

Falls, injuries, or near misses

Psychiatric crises or safeguarding concerns

Include full narrative of what occurred, action taken, and follow-up

Discharge Summary

Completed at the end of detox and shared (with consent) with GP or aftercare provider Includes:

Detox start and end dates
Medication regimen

Summary of progress and any complications

Recommendations for follow-up care or referrals

5.2 Record Storage & Confidentiality

All client records (digital or paper) must be:

Stored securely in a locked cabinet or password-protected digital system

Accessible only to authorised clinical staff

Maintained in accordance with the UK GDPR and Data Protection Act 2018
Retention Period (UK):
Clinical records must be kept for a minimum of 8 years after discharge (or until the client is 25 years old, if they were under 18 at the time of care), per NHS, HIS and CQC guidance

6. Infection Control & Safety

All home detox services must be delivered in a clean, safe, and risk-aware environment. Infection prevention and safety procedures are essential to protect both clients and staff and to maintain professional standards of clinical care.

6.1 Infection Control Procedures

Nurses and support staff are responsible for upholding strict infection prevention measures in line with UK infection control guidelines.

Standard Precautions

Hand Hygiene: Perform hand hygiene before and after all client contact using alcohol-based hand rub or soap and water

Personal Protective Equipment (PPE):

Gloves must be worn when administering medication, handling waste, or if contact with bodily fluids is likely

Masks, aprons, and eye protection used as needed based on risk

Sharps Safety:

Use approved sharps containers for any injectable medication (e.g. IM thiamine)

Do not recap needles

Transport sharps containers in accordance with local authority waste guidelines

Waste Management

Dispose of clinical waste (e.g. gloves, dressings, syringes) using yellow bags or sharps bins as per Health Technical Memorandum 07-01

Waste must be collected and disposed of by an authorised clinical waste contractor

Documentation of waste disposal must be retained

6.2 Home Environment Safety Assessment

Before detox begins, a home safety check must be conducted to ensure the environment is suitable for clinical care and emergency access.

Key Home Safety Checks Include:

Clear exit routes in case of emergency

Presence and working condition of smoke detectors

Pets managed or restricted to prevent interference with care delivery or infection risk

Sufficient lighting, heating, and cleanliness in care areas
Accessible toilet and wash facilities

7. Patient Rights & Confidentiality

All clients receiving home alcohol detox services are entitled to care that is respectful, informed, confidential, and person-centred. This policy affirms the rights of individuals and sets out how their privacy and autonomy will be protected throughout their treatment.

7.1 Patient Rights

Clients have the right to:

Be Treated with Dignity and Respect
Every person will be treated as an individual, without judgement, stigma, or discrimination, regardless of background, beliefs, or personal history.

Confidentiality of Personal and Health Information

All records will be kept private and secure in line with the UK GDPR and Data Protection Act 2018.

Information will only be shared with third parties (e.g. GPs, family, emergency services) with the client’s explicit consent, unless there is a legal or safeguarding duty to disclose.

Refuse or Withdraw Consent for Treatment
Clients have the legal right to decline any part of their care or withdraw consent at any time, provided they have capacity to make that decision.

Receive Information in Clear, Understandable Language
All care plans, risks, and procedures will be explained in plain, accessible language, and clients will be encouraged to ask questions and seek clarification at any time.

Participate in Decisions About Their Care
Clients are active partners in their treatment, with the right to contribute to care planning and make informed choices about detox, medication, and aftercare.

7.2 Confidentiality and Information Sharing

All staff must follow strict confidentiality procedures and only access client records on a need-to-know basis.

Verbal and written communications will be handled discreetly and professionally.

Clients will be asked to sign a Confidentiality Agreement and Consent to Share Information form, detailing:

Who information may be shared with (e.g. GP, family, aftercare providers)

The specific purposes of data sharing

Any breach of confidentiality must be reported and documented immediately under the service’s incident reporting and data protection policies.

Family or Household Education

Family/support persons are briefed on:

Emergency procedures and when to call for help

Keeping the environment calm, quiet, and substance-free

Not interfering with medication or treatment

Managing children or pets during care visits

8. Professional Standards & Ethics

All clinical staff involved in delivering detox services must uphold the highest standards of professionalism, clinical integrity, and ethical conduct. This ensures client safety, builds public trust, and aligns with the expectations of UK regulatory bodies.

8.1 Registration, Licensure & Insurance

Active Registration
All nurses and healthcare professionals must maintain current registration with their respective regulatory body (e.g. NMC, HCPC, or GMC).

Professional Indemnity Insurance
Staff must hold valid professional indemnity and public liability insurance, either individually or through the service provider, as required by UK law and the NMC Code of Practice.

8.2 Scope of Practice & Legal Compliance

Practitioners must work within the legal scope of their role and professional competence, in accordance with:

The NMC Code (for nurses)

Health Improvement Scotland fundamental standards

Applicable national legislation such as the Mental Capacity Act 2005 and Care Act 2014

Staff may not engage in activities that exceed their training or registration (e.g. prescribing without qualification).

8.3 Continuing Professional Development (CPD)

All staff are expected to:

Undertake regular CPD, particularly in areas of substance misuse, mental health, safeguarding, and trauma-informed care

Stay up to date with evidence-based practices in alcohol withdrawal management

Participate in supervision and reflective practice where available

8.4 Safeguarding and Ethical Reporting

All staff are legally and ethically required to report concerns related to:

Abuse, neglect, or self-neglect

Domestic violence or exploitation

Risk to children or vulnerable adults in the household

Staff must follow the service’s safeguarding policy and escalate concerns to the designated safeguarding lead or relevant local authority without delay.

Note: Failure to report safeguarding concerns may result in disciplinary action and/or professional referral to the NMC or appropriate regulatory body.

9. Discharge & Follow-Up

Safe and structured discharge planning is a vital component of effective alcohol detox care. It ensures the client transitions smoothly into continued recovery support and reduces the risk of relapse or adverse outcomes. Every client will receive personalised discharge guidance and appropriate follow-up.

9.1 Discharge Criteria

Clients will be discharged from the home detox programme when all of the following conditions are met:

Withdrawal symptoms have significantly subsided (CIWA-Ar score consistently below clinical threshold)

Vital signs are stable and within normal range

Client is medically and mentally stable with no immediate risk of complications

Detox medications are tapered and no longer required (or handed over to GP if ongoing)

Discharge must be authorised by the supervising nurse or clinician, with full documentation recorded in the clinical notes.

9.2 Post-Detox Referrals & Resources

Each client will receive a tailored aftercare plan, including referrals to appropriate recovery and mental health services such as:

Outpatient addiction services (e.g. NHS or private programmes)

Counselling or psychological therapy for trauma, mental health, or relapse prevention

Local AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) groups

Support for co-occurring conditions, such as anxiety, depression, or PTSD

Family members may also be signposted to Al-Anon, SMART Recovery Family & Friends, or counselling support.

9.3 Follow-Up & Monitoring

To support long-term recovery and continuity of care, the following post-detox steps will be offered:

Follow-up call or check-in within 24–72 hours of discharge

To assess well-being, answer questions, and support next steps

Patient satisfaction survey

Feedback is gathered to improve service quality, identify gaps, and maintain HIS standards

Discharge summary shared with the client’s GP or key worker (with consent)

10. Contact & Communication Policy

Clear, timely, and compassionate communication is essential throughout the detox process. Our service ensures clients and their families feel supported, informed, and safe at all times.

10.1 Availability

24/7 On-Call Support
Clients have access to a dedicated on-call nurse or clinician around the clock during the detox period to address urgent concerns, manage symptoms, and provide reassurance.

10.2 Family and Support Contact

With the client’s explicit consent, the service will provide regular updates to a designated family member or support person to keep them informed of progress and any changes in condition.

Family/support contacts will be made aware of emergency protocols and advised when to escalate concerns or call emergency services

10.3 Communication Documentation

All client and family communications, including phone calls, home visits, and emails, will be logged accurately and promptly in the client record.

Logs will include:

Date and time of contact

Names of parties involved

Summary of topics discussed

Any actions or follow-up agreed upon

Communication records will be treated as confidential and stored securely in line with data protection policies.