Amanda S Eloma1, Jason M Tucciarone2, Edmund M Hayes1, Brian D Bronson3. 1. a Stony Brook University , School of Pharmacy and Pharmaceutical Sciences , Stony Brook , NY , USA. 2. b Stony Brook University , School of Medicine , Stony Brook , NY , USA. 3. c Department of Psychiatry , Stony Brook University, School of Medicine , Stony Brook , NY , USA.
Abstract
BACKGROUND: The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal. OBJECTIVES: To evaluate the prescribing patterns and appropriate use of the CIWA-Ar protocol in a general hospital setting, as determined by the presence or absence of documented AWS risk factors, patients' ability to communicate, and provider awareness of the CIWA-Ar order. METHODS: This retrospective chart review included 118 encounters of hospitalized patients placed on a CIWA-Ar protocol during one year. The following data were collected for each encounter: patient demographics, admitting diagnosis, ability to communicate, and admission blood alcohol level; and medical specialty of the clinician ordering CIWA-Ar, documentation of the presence or absence of established AWS risk factors, specific parameters of the protocol ordered, service admitted to, provider documentation of awareness of the active protocol within 48 h of initial order, total benzodiazepine dose equivalents administered and associated adverse events. RESULTS: 57% of patients who started on a CIWA-Ar protocol had either zero or one documented risk factor for AWS (19% and 38% respectively). 20% had no documentation of recent alcohol use. 14% were unable to communicate. 19% of medical records lacked documentation of provider awareness of the ordered protocol. Benzodiazepine associated adverse events were documented in 15% of encounters. CONCLUSIONS: The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.
BACKGROUND: The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal. OBJECTIVES: To evaluate the prescribing patterns and appropriate use of the CIWA-Ar protocol in a general hospital setting, as determined by the presence or absence of documented AWS risk factors, patients' ability to communicate, and provider awareness of the CIWA-Ar order. METHODS: This retrospective chart review included 118 encounters of hospitalized patients placed on a CIWA-Ar protocol during one year. The following data were collected for each encounter: patient demographics, admitting diagnosis, ability to communicate, and admission blood alcohol level; and medical specialty of the clinician ordering CIWA-Ar, documentation of the presence or absence of established AWS risk factors, specific parameters of the protocol ordered, service admitted to, provider documentation of awareness of the active protocol within 48 h of initial order, total benzodiazepine dose equivalents administered and associated adverse events. RESULTS: 57% of patients who started on a CIWA-Ar protocol had either zero or one documented risk factor for AWS (19% and 38% respectively). 20% had no documentation of recent alcohol use. 14% were unable to communicate. 19% of medical records lacked documentation of provider awareness of the ordered protocol. Benzodiazepine associated adverse events were documented in 15% of encounters. CONCLUSIONS: The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.
Authors: Tessa L Steel; Shewit P Giovanni; Sarah C Katsandres; Shawn M Cohen; Kevin B Stephenson; Ben Murray; Hillary Sobeck; Catherine L Hough; Katharine A Bradley; Emily C Williams Journal: Addict Sci Clin Pract Date: 2021-03-24
Authors: Tessa L Steel; Majid Afshar; Scott Edwards; Sarah E Jolley; Christine Timko; Brendan J Clark; Ivor S Douglas; Amy L Dzierba; Hayley B Gershengorn; Nicholas W Gilpin; Dwayne W Godwin; Catherine L Hough; José R Maldonado; Anuj B Mehta; Lewis S Nelson; Mayur B Patel; Darius A Rastegar; Joanna L Stollings; Boris Tabakoff; Judith A Tate; Adrian Wong; Ellen L Burnham Journal: Am J Respir Crit Care Med Date: 2021-10-01 Impact factor: 21.405