A Multidisciplinary Approach to Improving the Treatment of Alcohol Withdrawal Syndrome

Purpose:
Alcohol withdrawal syndrome is a potentially life threatening condition. Appropriate treatment can reduce the risk of seizures or delirium tremens. Literature suggests the importance of preventing the signs of withdrawal prior to their appearance, as well as managing these symptoms as they appear.

Relevance/Significance:
Recent data over a three-year period identifies a 50% increase in admissions for alcohol withdrawal. Comparative state data rates this organization as one of four with the highest incidence for a discharge diagnosis of alcohol withdrawal. A review of the clinical environment identified gaps and variation in practice. This quality improvement initiative centers on patient safety and the empowerment of nurses to become experts in the care of this patient population.

Strategy and Implementation:
An inter-professional team was established to guide this clinical environment. The success of the improvement work was measured by four key indicators: workplace and environmental safety; transfer to a higher level of care; length of stay (LOS) and use of patient sitters. The protocol was created with the goal of prevention of withdrawal symptoms, as well as symptom management as they emerge. During the three days of the protocol, the patient receives a scheduled dose of oral benzodiazepines, and as needed orders of additional benzodiazepine and haloperidol. The RN assesses the patient by using the Sedation Agitation Scale (SAS) scale. One medical unit was designated as the High Risk Detoxification Unit, thus allowing the nurses in this unit to receive additional training. In order for optimal training of the nurses on this unit, a mentorship program was initiated with Psychiatry RNs who would round on these patients three times a day for the first three months of the program.

Evaluation:
This quality improvement initiative met several outcomes: A 63% decrease in the number of security interventions; a 95% reduction in ICU transfers(42 in 2013 to 2 in 2014); a reduction of the LOS by 1.6 days (5.3 in 2013 to 3.7 in 2014);a 36% reduction in sitter hours (57,600 hours to 6752 hours) thereby decreasing sitter full time equivalents (FTE). This quality initiative has marked success.

Implications for Practice:
With the success of this program, the nursing staff has been extremely educated and empowered on the process of alcohol withdrawal.Overall, this program has been viewed as a success at this institution and continues to provide safe and quality care to those patients experiencing alcohol withdrawal.