2.50
Hdl Handle:
http://hdl.handle.net/10755/157051
Category:
Abstract
Type:
Presentation
Title:
Managing Alcohol Withdrawal in a Community Critical Care Unit
Author(s):
Small, Kathryn R.
Author Details:
Kathryn R. Small, RN,MS,CCRN,ACNP, Emerson Hospital, Concord, Massachusetts, USA, email: Kate@baystatesmalls.org
Abstract:
PURPOSE: Alcohol withdrawal is a disease managed in every critical care unit (CCU) in the country. Twenty percent of all patients admitted to the hospital are alcohol dependent. As a community hospital we often care for patients in our CCU who failed alcohol withdrawal on oral regiments and require continuous intravenous benzodiazepines. Together, the nurses and unit leaders identified this as an underserved subset and began a quality initiative project in 2004 to improve care for this unique population. DESCRIPTION: For varied reasons our patient population exploded in early 2004. The unit-based nurse practice council realized that a more standardized and evidence-based approach to caring for this population was needed. After gathering a team of physicians, nurses, and pharmacists with an interest in this population, the literature was reviewed and areas for improvement identified. The 5 focus areas were nursing education regarding alcohol withdrawal and the prevention of complications, standardization of patient assessment, an admission order set to facilitate care, increased use of long-acting benzodiazepines when able, and standardization of lorazepam infusion titration. Nursing education has been provided at competencies and the CIWA protocol was adopted as our standard for ongoing assessments. Together with the medical director and pharamacists the nurse practice council developed a CIWA driven lorazepam protocol which resulted in a coordinated order set. Finally, in subsequent revisions to our protocol, we opted to increase our use of longer acting benzodiazepines once the patient is able to tolerate orals. Yearly to bi-yearly retrospective reviews have provided us with data to guide our progress. EVALUATION/OUTCOMES:We have thus far implemented interventions aimed at all 5 focus areas, including an order set, a CIWA driven lorazepam drip protocol, and an oral diazepam protocol. Since 2005, our combined multifaceted approach to this population has produced positive outcomes. In 2008 we saw a decrease both in the number of patients requiring lorazepam infusions and decreased length of time they required the infusion, length of stay both in the CCU and the hospital has decreased, and, perhaps most importantly, our complications related to withdrawal were fewer. Overall this project has resulted in improved patient outcomes and increased staff satisfaction with the quality of care being provided.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleManaging Alcohol Withdrawal in a Community Critical Care Uniten_GB
dc.contributor.authorSmall, Kathryn R.en_GB
dc.author.detailsKathryn R. Small, RN,MS,CCRN,ACNP, Emerson Hospital, Concord, Massachusetts, USA, email: Kate@baystatesmalls.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157051-
dc.description.abstractPURPOSE: Alcohol withdrawal is a disease managed in every critical care unit (CCU) in the country. Twenty percent of all patients admitted to the hospital are alcohol dependent. As a community hospital we often care for patients in our CCU who failed alcohol withdrawal on oral regiments and require continuous intravenous benzodiazepines. Together, the nurses and unit leaders identified this as an underserved subset and began a quality initiative project in 2004 to improve care for this unique population. DESCRIPTION: For varied reasons our patient population exploded in early 2004. The unit-based nurse practice council realized that a more standardized and evidence-based approach to caring for this population was needed. After gathering a team of physicians, nurses, and pharmacists with an interest in this population, the literature was reviewed and areas for improvement identified. The 5 focus areas were nursing education regarding alcohol withdrawal and the prevention of complications, standardization of patient assessment, an admission order set to facilitate care, increased use of long-acting benzodiazepines when able, and standardization of lorazepam infusion titration. Nursing education has been provided at competencies and the CIWA protocol was adopted as our standard for ongoing assessments. Together with the medical director and pharamacists the nurse practice council developed a CIWA driven lorazepam protocol which resulted in a coordinated order set. Finally, in subsequent revisions to our protocol, we opted to increase our use of longer acting benzodiazepines once the patient is able to tolerate orals. Yearly to bi-yearly retrospective reviews have provided us with data to guide our progress. EVALUATION/OUTCOMES:We have thus far implemented interventions aimed at all 5 focus areas, including an order set, a CIWA driven lorazepam drip protocol, and an oral diazepam protocol. Since 2005, our combined multifaceted approach to this population has produced positive outcomes. In 2008 we saw a decrease both in the number of patients requiring lorazepam infusions and decreased length of time they required the infusion, length of stay both in the CCU and the hospital has decreased, and, perhaps most importantly, our complications related to withdrawal were fewer. Overall this project has resulted in improved patient outcomes and increased staff satisfaction with the quality of care being provided.en_GB
dc.date.available2011-10-26T19:22:41Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:22:41Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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