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Safe Clinical Course through Alcohol Withdrawal

Sunday, November 1, 2009

Constance A. Adams, BSN, RN
School of Nursing, Purdue University Calumet, Hammond, IN
Kathleen Rich, PhD, RN, CCNS, CCRN-CSC, CNN
Patient Care Services, LaPorte Regional Health System, LaPorte, IN

Learning Objective 1: describe the relationship between severity of alcohol withdrawal symptoms and choice of pharmacological therapy for AWS.

Learning Objective 2: identify the theoretical structures used in this evidence based implementation process to facilitate translating evidence into practice.

Hospital nurses commonly deal with the complexities of managing the care of patients in acute alcohol withdrawal.  Patients who are admitted for alcohol withdrawal syndrome (AWS) may manifest symptoms from very mild, to severe and life threatening. Nurses are at the front line, providing close supervision to make dynamic decisions about care.  Specialized knowledge of the physiology of AWS facilitates a patient centered approach to care including pharmacological and non pharmacological  support which may be required to safely manage symptoms. 

Evidence shows that when a standardized tool to guide assessment and treatment  is employed by nurses, the target outcome for most patients is a safe course of withdrawal.  A nurse managed protocol was developed  by a multidisciplinary team based on best available evidence. The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) (Sullivan, Sykora, Schneiderman, Naranjo, & Sellers, 1989) was chosen to quantify alcohol withdrawal symptoms when patients were able to participate. The protocol provided decision support for the choice of an appropriate setting and medication regimen for management of symptoms. The dose and frequency of a short acting benzodiazepine was based on the the assessed severity of symptoms and guided the frequency of patient re-assessment with the CIWA-Ar scale by nursing staff.   Patients’ safe passage through risky illness like AWS depends upon health care providers using the best available evidence.

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