Running head: TEACHING ALCOHOL WITHDRAWAL TO NURSES 1

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1 Running head: TEACHING ALCOHOL WITHDRAWAL TO NURSES 1 Connections and Recommendations Paper: Teaching Alcohol Withdrawal Protocol to Nurses Group Members: Jennie Nguyen, Kristen Deans, Laura Zacharias, & Ryan Gourley Written by: Jennie Nguyen University of San Francisco

2 TEACHING ALCOHOL WITHDRAWAL TO NURSES 2 Alcohol withdrawal syndrome (AWS) occurs when alcohol dependence is present and alcohol intake is suddenly discontinued. Nurses are responsible for providing proper care, which means first receiving proper education and training. Patients who experience AWS in the hospital setting tend to have a longer length of stay. With that being known, our PICOT question is presented as: 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 nurses who have not had training over a three month period? We found eight peer-reviewed articles that helped us move closer to our answer. First, a pilot study published by the American Journal of Critical Care (2013) wanted to see if lorazepam and the combination of lorazepam and ethanol will safely and efficiently prevent AWS in patients with acute coronary syndromes. The researchers concluded that both interventions were safe and that the overall length of stay was about the same as well (Fullwood et al., 2013). A study published by The Canadian Journal of Hospital Pharmacy (2011) wanted to assess the efficacy and safety of a combination fixed-schedule and symptom-triggered BZD dosing protocol for AWS (Ng, Dahri, Chow, & Legal, 2011). Another study published by Journal of The American Geriatrics Society (2014) evaluated if implementing symptomtriggered administration of a benzodiazepines (BZD) protocol reduces the severity, duration, and complications of AWS, which it did in adults aged 70 and older (Taheri et al., 2014). Similarly, Southern Medical Journal (2015) published a study wanting to know if implementing CIWA and BZD-practices will reduce length of stay in patients with AWS at the South Texas Veterans Health Care System (Waye, Wong, & Lee, 2015). One study published by MedSurg Nursing in 2012 focuses on how nurses have a difficult time identifying the signs and symptoms of AWS. Nurses also have trouble with gauging the

3 TEACHING ALCOHOL WITHDRAWAL TO NURSES 3 severity of AWS, which can lead to ineffective sedation with (BZD) (Donnelly, Kent-Wilkinson, & Rush, 2012). This tremendously helps with our PICOT question because it identifies what the underlying issue of AWS is: we must first teach nurses how to correctly identify the symptoms in order to improve assessment skills, so that we can effectively treat patients and prevent the lifethreatening effects of AWS. MedSurg Nursing also published another study in 2014 that provided a sample of CIWA and that symptom-based treatment of AWS is more beneficial for the patient compared to fixed-dose management (Skinner, 2014). Drug & Alcohol Review (2007) published a study that aimed to identify current practices for screening by nurses, determine knowledge of substance use, and self-reporting skills in managing patients with drug- and alcohol-related problems. We found that nurses knew very little (Griffiths, Stone, Tran, Fernandez, & Ford, 2007). Similarly, a study published by Contemporary Nurse (2009) compared two types of nursing education and training for AWS in an Australian rural area, a self-directed competency training package and a more traditional inservice program (Daly, Kermode, & Reilly, 2009) In conclusion, the results from the studies collectively show a need to train nurses in CIWA to improve patient care, reduce length of hospital stay, and lower costs. Training nurses will provide them the objective assessment skills necessary to identify key alcohol withdrawal symptoms and initiate interventions more effectively to reduce serious and even fatal complications from AWS. The main lesson is that proper training is key to providing proper care. From our findings, we believe that we must design a study in order to assess the implications of implementing a training program for nurses regarding CIWA to answer our PICOT question.

4 TEACHING ALCOHOL WITHDRAWAL TO NURSES 4 References 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), Donnelly, G., Kent-Wilkinson, A., & Rush, A. (2012). The Alcohol-Dependent Patient in Hospital: Challenges for Nursing. MedSurg Nursing, 21(1), Fullwood, J. E., Mostaghimi, Z., Granger, C. B., Washam, J. B., Bride, W., Yanfang, Z., & Granger, B. B. (2013). ALCOHOL WITHDRAWAL PREVENTION: A RANDOMIZED EVALUATION OF LORAZEPAM AND ETHANOL-A PILOT STUDY. American Journal Of Critical Care, 22(5), doi: /ajcc Griffiths, R. D., Stone, A., Tran, D. T., Fernandez, R. S., & Ford, K. (2007). Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol?. Drug & Alcohol Review, 26(5), Ng, K., Dahri, K., Chow, I., & Legal, M. (2011). Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital. The Canadian Journal of Hospital Pharmacy, 64(6), Skinner, R. (2014). Symptom-Triggered vs. Fixed-Dosing Management of Alcohol Withdrawal Syndrome. MedSurg Nursing, 23(5), Taheri A, Dahri K, Chan P, Shaw M, Aulakh A, Tashakkor A. Evaluation of a Symptom- Triggered Protocol Approach to the Management of Alcohol Withdrawal Syndrome in Older Adults. Journal Of The American Geriatrics Society [serial online]. August 2014;62(8):

5 TEACHING ALCOHOL WITHDRAWAL TO NURSES 5 Waye, C., Wong, M., Lee S. (January 2015). Implementation of a CIWA-Ar Alcohol Withdrawal Protocol in a Veterans Hospital. Southern Medical Journal,108, doi: /SMJ