Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-10-2024

Graduate Advisor

Brittania Phillips, DNP, APRN, PMHNP-BC PMHNP Track Lead

Committee

Lisa Green, PhD, RN

Sarah Williamson, MSN, RN

Abstract

Problem: Individuals who drink alcohol excessively are at great risk for alcohol withdrawal syndrome (AWS) when hospitalized. Symptoms and their severity differ for everyone, and research shows that the identification and treatment of AWS is challenging and often inadequate. Mild AWS is often overtreated, while moderate to severe AWS is often underdiagnosed and undertreated, placing individuals at risk for longer hospital stays, more time needed in critical care units, and a variety of unintended consequences.

Methods: This evidence-based practice project had a pre-post intervention design in which the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) was implemented to promptly identify individuals at risk for moderate to severe (complicated) AWS. Data was collected via retrospective chart review before the PAWSS implementation, followed by a prospective chart review after implementation. Data included length of stay, time spent in critical care units, timeliness of withdrawal protocol initiation, severity of withdrawal, and benzodiazepine usage for AWS. Independent samples T-tests were conducted to analyze the difference between data for the two groups.

Results: A statistically significant difference was found between the following outcomes: time from arrival to CIWA-Ar protocol initiation, time from arrival to prophylactic Librium administration, total length of hospital stay, time spent in the ICU/IMU, total Ativan administration, and the highest recorded CIWA-Ar score. There was also a decrease noted between transfers of patients to a higher level of care by 7.3%.

Implications for Practice: Widespread utilization of the PAWSS tool in inpatient settings could aid in promptly and accurately identifying patients at risk of complicated AWS and improve treatment and patient outcomes.

Download

Share

COinS