Reducing Hospital Acquired Conditions through the appropriate use of Clinical Indications Withdrawal of Alcohol Protocol

Purpose:
The purpose of the performance improvement project was to offer recommendations for the consistent practices in the management of alcohol abuse patients. By implementing a Clinical Indications Withdrawal of Alcohol Protocol, standardization of care would improve clinical outcomes.

Significance:
Nurses utilizing a Clinical Indications Withdrawal of Alcohol protocol consistently manage patients with geriatric and psychiatric alcohol abuse issues resulting in a decrease in excessive hospital stays, companion (sitter) utilization, physical restraints, employee injuries and patient falls.

Strategy and Implementation:
A performance improvement team conducted a comprehensive literature review, brainstormed and constructed a fishbone diagram to understand the scope of the existing problem of the management of alcohol abuse patients. The team analyzed historical data to identify areas of opportunity for improvement: long hospital stays, excessive falls, restraints, sitters and employee injuries in caring for this population. The team decided to explore and introduce evidence-based Clinical Indications Withdrawal of Alcohol protocols. The team collaborated with the Psychiatric Medical Director to develop and implement a Clinical Indications Withdrawal of Alcohol protocol. Additionally, the team developed, trialed, modified and implemented a Sitter Risk Assessment tool. Finally, the team revised the sitter role and responsibilities.

Evaluation:
After implementing the Clinical Indications Withdrawal of Alcohol protocol the hospital has experienced a 44% reduction in sitter hours, 35% reduction in restraints, zero employee injuries and a 5% reduction in falls. Nurses report higher satisfaction with the improved management of their patients.

Implications for Practice:
The implementation of the Clinical Indications Withdrawal of Alcohol protocol assisted in standardizing care and empowered nurses to be active in the management of the patients with high risk for alcohol withdrawal, improving clinical outcomes and reducing hospital acquired conditions.