Running head: TEACHING ALCOHOL WITHDRAWAL TO NURSES 1

Transcription

1 Running head: TEACHING ALCOHOL WITHDRAWAL TO NURSES 1 TEACHING ALCOHOL WITHDRAWAL PROTOCOL TO NURSES Kristen Deans, Jennie Nguyen, Laura Zacharias, Ryan Gourley University of San Francisco

2 TEACHING ALCOHOL WITHDRAWAL TO NURSES 2 Teaching Alcohol Withdrawal Protocol to Nurses Background and Significance Addressing Alcohol Withdrawal in hospital patients is notoriously difficult and often largely mismanaged (Donnelly, Kent-Wilkinson, & Rush, 2012). Alcohol Withdrawal Syndrome (AWS) can be managed well under ideal circumstances with proper medication administration, and closely monitoring patients. (Daly, Kermode, & Reilly, 2009). Care of AWS patients is not ideal because nurses caring for these patients are not trained to use the protocols and screening tools to properly assess for symptoms of alcohol withdrawal. R. Skinner (2014) states that, Without appropriate screening and intervention, patients with AWS may experience longer, more complicated hospital admissions, (p. 307). Another issue with implementing AWS protocol is patient s lack of reliable reporting of their alcohol intake due to social stigmas associated with alcoholism especially from the medical community (Donnelly et al., 2012). Research has shown us that projects focused around training to use protocols and screening, have a positive impact on patient outcomes (Dodge, 2010). For example, in the past, hospitals have focused on sepsis screenings after they determined that this issues was widely present in hospitals nationwide and was a major contributors to poor patient outcomes (Campbell, 2008). Subsequently, after training, the research reflected progressive changes in patient care around sepsis in the hospital (Campbell, 2008). The purpose of this intervention will be to determine whether the teaching strategies were effective in demonstrating positive patient outcomes measured by reduced length of stay in the hospital for AWS patients. The research (PICOT) question is then stated: In MedSurg/ICU nurses caring for adult patients showing AWS, what effect on decreasing hospital stay on patients who have been treated by nurses who have been trained on the CIWA protocol compared with those nurse who have not had training over a three month period? This data from other aspects of patient care calls for the same strategies to be applied in the teaching of proper AWS assessment according to protocol to nurses in hospitals. Review of the Literature Even though a lot of the research surrounding AWS is centered on medical judgment about what medications are more effective in treating alcohol withdrawal symptoms, it is truly the nursing AWS is treated based on the presentation of symptoms; hence the entire treatment plan is dependent upon the nurse s effective assessment of symptoms. The biggest problem with this is that a majority of the assessment criteria for AWS is

3 TEACHING ALCOHOL WITHDRAWAL TO NURSES 3 highly subjective (Skinner, 2014). For example, Skinner (2014) goes on to explain that the protocol will ask the nurse to rate whether the patient has moderately severe hallucinations, severe hallucinations, or extremely severe hallucinations, (p. 309). These aspects are up to then nurses clinical judgment, but since nurses have not been properly trained on how to screen these specific symptoms in this population of patients, it is highly probable that their assessments are not accurate, and thus the patients symptoms are not being properly managed. So, it can be seen that the nursing implications are hugely important in the treatment of AWS (Daly et al., 2009). Given how essential nursing assessment is to the application of AWS protocols, the target population for this study will be nurses working in inpatient hospital settings particularly on med-surg and intensive care units. Medical-surgical nurses and ICU nurses deal with alcohol withdrawal patients when they are most unstable, these nurses are ideal candidates for this training intervention. Patients in this arena of healthcare have other medical issues going on that can more easily lead to them becoming critically ill or having a seizure from their withdrawal symptoms (Skinner, 2014). Given this fact, it will also be easier to see the impact that a good assessment can have on these patients because their medical status is so dynamic and unstable. Methods The intervention will consist of an in-service training program using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) AWS Protocol (Skinner, 2014). One group of Medical Surgical and ICU nurses will be asked to attend a workshop on their day off where they will be briefed on the protocol and appropriate documentation pertaining to Alcohol Withdrawal patients. The CIWA will be broken down item by item and discussed so that nurses have a clearer idea about what things like severe hallucinations looks like compared to extremely severe hallucinations; and furthermore what the implications of these assessment findings mean to their patients overall plan of care (Skinner, 2014). After the briefing, the nurses in the test group will take part in a simulation to practice their new skills, and then they will perform a teach back of the execution of the protocol. This test group will be compared to another group of Medical-Surgical/ICU nurses working in the same, or similar settings who have not had the protocol teaching intervention. Conclusions, Implications, and Recommendations

4 TEACHING ALCOHOL WITHDRAWAL TO NURSES 4 Looking into the literature, it was apparent that a study like this has not been conducted regarding the use of CIWA with alcohol withdrawal patients, so the focus then shifted to finding similar study designs using different screening tools. Our aim was to find good examples of pre and post data following teaching of a screening tool to a nurse population. Finding evidence in the literature that proper teaching of the use of screening tools and protocols improve patient care and reduce overall length of stay in the hospital, has positive implications for patients and the healthcare system on the whole as it will allow us to conserve money and resources (Skinner, 2014). Proper assessment of our patients is paramount to providing good patientcentered care especially when it comes to dealing with a condition such as AWS, which can be well managed with the right tools, or fatal when major clinical signs are missed. To complete a study in this subject matter it will be necessary to obtain background information about the CIWA AWS protocol. Additionally, it will be necessary to find information about the impact of co-morbidities associated with under treated AWS and how it affects the patients care plans. Background information on the studies and methods used to teach the sepsis will be needed for a valid comparison. Our foreground information will look at an analysis of the patient care given by both the test and the control groups to determine which group had more successful patient outcomes. Our hope is that we can design a study free from bias that will demonstrate the true effects of training nurses to deal with, and better treat this difficult patient population. Designing investigative studies like this one will provide us with better data to be able to evaluate our treatment effectiveness in patients suffering from alcohol withdrawal nationwide.

5 TEACHING ALCOHOL WITHDRAWAL TO NURSES 5 References Campbell, J. (2008). The effect of nurse champions on compliance with Keystone intensive care unit sepsisscreening protocol. Apr-Jun;32(2):158. Critical Care Nursing Quarterly, 31(3), Daly, M., Kermode, S., & Reilly, D. (2009). Evaluation of clinical practice improvement programs for nurses for the management of alcohol withdrawal in hospitals. Contemporary Nurse, 31(2), Dodge, M. (2010). SIRS: a systematic approach for medical-surgical nurses to stop the progression to sepsis. MEDSURG Nursing, 19(1), Donnelly, G., Kent-Wilkinson, A., & Rush, A. (2012). The Alcohol-Dependent Patient in Hospital: Challenges for Nursing. MedSurg Nursing, 21(1), Skinner, R. (2014). Symptom-Triggered vs. Fixed-Dosing Management of Alcohol Withdrawal Syndrome. MedSurg Nursing, 23(5),