Improving Alcohol Withdrawal Outcomes in Acute Care

Melson, Jo; Kane, Michelle; Mooney, Ruth; McWilliams, James R.; Horton, Terry

doi:10.7812/tpp/13-099

Cited by 18 publications

(10 citation statements)

References 13 publications

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“…[15][16][17] Anecdotally, nurses at the bedside are the care providers who often become aware of clues from a patient's family about a patient's alcohol use. 18 Critical care nurses quickly establish rapport and relationships with their patients and the patients' families and are extremely well placed to gain information about alcohol use. Regrettably, only a single study 19 has shown that the completion of alcohol screening by family members could be as effective and valid as patient self-reporting.…”

Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

“…This practice might halt the progression from mild to severe withdrawal and prevent delirium tremens. 18,20 Use of Serum Biomarkers to Detect an AUD A serum laboratory test that could highlight chronic alcohol use would be helpful, especially when an alcohol history is unobtainable. Laboratory tests such as serum ethanol levels only reveal recent alcohol consumption, not the chronic intake of alcohol that predisposes to withdrawal.…”

Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

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Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith

Jutel

2016

Critical Care Nurse

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Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28–39)

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Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith

Jutel

2016

Critical Care Nurse

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“…As many as 30% of patients with AWS are admitted to Intensive Care Units (ICU) and while in the ICU those affected tend to have more clinical complications (Adams and Ferguson, 2017). Management of symptoms include early identification of at-risk individuals and continual assessment of symptoms and treatment plans (Melson et al, 2014;Perry, 2014;Salottolo et al, 2017). Benzodiazepines are shown to be an effective therapy for AWS and are a main component of treatment for patients experiencing AWS symptoms particularly because of their efficacy in reduction or prevention of seizures (Amato et al, 2010;Perry, 2014;Adams and Ferguson, 2017).…”

mentioning

confidence: 99%

Validity and Reliability of an Alcohol Withdrawal Clinical Assessment Scale for Use with Acutely Ill Patients: An Abbreviated Version of the CIWA-Ar

Gee

Knapp

Miller³

et al. 2017

International Journal of Research in Nursing

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The number of people in the United States admitted to hospitals with alcohol use disorder is increasing. Screening for alcohol dependence is a critical component to prevent alcohol withdrawal syndrome which places both the patient and staff at risk for injury. Management of symptoms includes early identification of at-risk individuals and continuous assessment of symptoms and treatment plans. In light of the growing number of patients in need of care for alcohol disorders, our goal was to assess the reliability and validity of a more concise version of the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) to enhance clinical efficiency without compromising the integrity of this diagnostic instrument. Members of an interdisciplinary team researched and revised the full 10-item CIWA-Ar to six items. Clinicians were trained on how to conduct and document their diagnostic findings using this abridged 6-item instrument. The research team then examined the psychometric properties of the new brief instrument to determine reliability and validity. The research team confirmed content validity. Based on data drawn from multiple sites, we compared the 10-item version of this instrument to the 6-item version; this produced a strong positive correlation, thereby satisfying concurrent criterion validity. Correlational analysis of 71 cases confirmed robust interrater reliability. This pilot study suggests that the new 6-item scale is a valid and reliable instrument, essentially performing equivalently to the 10-item version. Our research team therefore suggests further multi-site studies to confirm our findings of this more concise diagnostic instrument.

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“…Alcohol dependence is one of the commonest psychiatric disorders, second only to major depression [1]. Approximately 50% of those with alcohol dependence experience withdrawal symptoms & upto 10% experience delirium tremens [2]. Withdrawal symptoms usually start about 6 hours after alcohol cessation & withdrawal seizure is frequently the first sign occuring within 6-48 hours of alcohol cessation.…”

mentioning

confidence: 99%