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Sunday, November 1, 2009
Learning Objective 1: Identify two benefits of implementing an evidence based alcohol withdrawal protocol.
Learning Objective 2: Identify two validated assessment tools that can be used for nursing assessment of risk for or actual alcohol withdrawal.
Alcohol withdrawal is a common occurrence in acute care hospitalization. Staff within the critical care area was challenged to identify measures to increase the safety of patients going through alcohol withdrawal. An interdisciplinary group including nurses, physicians, pharmacists and clinical nurse specialists developed an evidence-based alcohol withdrawal protocol and policy. Recognizing that alcohol withdrawal was frequently not identified by nurses, assessment tools in the literature were reviewed for reliability and ease of use. The CAGE questionnaire and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) were selected to help identify the patient at risk for or experiencing alcohol withdrawal. Literature validated that symptom triggered approaches to treating alcohol withdraw were effective, increased patient safety, decreased medication needs and shortened length of stay. An alcohol withdrawal order set based on the nurse assessed symptoms was developed. The assessment tools and order set were constructed in the electronic record for ease of use. Staff attended an inservice or completed a computer based learning course and completed a case study to practice using the assessment tools. The protocol has been implemented and staff has identified patients that are responding promptly to treatment of the assessed alcohol withdrawal symptoms. Outcomes of this project have included increased staff awareness of the patient at risk for alcohol withdrawal and enhanced patient safety based on prompt treatment of alcohol withdrawal symptoms. Ongoing evaluation of the protocol will include data collection and analysis regarding protocol use, patient complications, need for transfer to higher level of care and length of stay.