Experience with an adult alcohol withdrawal syndrome practice guideline in internal medicine patients.
OBJECTIVE
To standardize treatment of alcohol withdrawal syndrome (AWS) in internal medicine patients using an adult AWS practice guideline with a symptom-triggered management approach.


METHODS
Prospective interventional (pilot group) and retrospective (control group).


METHODS
University teaching hospital.


METHODS
Thirty-two internal medicine patients identified as being at risk for AWS and treated according to the AWS practice guideline who were compared with 49 internal medicine patients managed with nonstandardized approaches.


METHODS
Patients in the pilot group were assessed using the AWS type indicator. They received lorazepam, clonidine, or haloperidol, based on AWS type indicator assessment and adult AWS practice guideline criteria.


RESULTS
Data collected and analyzed were drugs administered to control AWS symptoms, use of sitters and physical restraints, length of hospital stay, and discharge from hospital receiving tapered drug therapy. Pilot patients received 46.6% less benzodiazepine (p=0.001), 20% more clonidine (p=0.01), and 18.2% more haloperidol (p=0.002) than control patients. No drug therapy was required in 19% of pilot patients compared with 2% of controls (p=0.01). Significantly more control (71.4%) than pilot patients (18.8%) were discharged with tapered benzodiazepine therapy (p<or=0.01). No significant differences were found between groups for sitters, restraints, or hospital length of stay.


CONCLUSIONS
This pilot project suggests that internal medicine patients at risk for AWS can be managed with a standardized, symptom-triggered approach using decreased amounts of benzodiazepine in combination with adjunctive agents to treat adrenergic hyperactivity and delirium. Further data are necessary to determine the impact of the practice guideline on patient outcome measurements.
Stanley
Karen M
KM
Department of Therapeutic Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA. stanleyk@musc.edu
Worrall
Cathy L
CL
Lunsford
Shayna L
SL
Simpson
Kit N
KN
Miller
Justin G
JG
Spencer
Anne P
AP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006784:Hospitals, Teaching; D007388:Internal Medicine; D007902:Length of Stay; D008140:Lorazepam / Q000627:therapeutic use; D010865:Pilot Projects; D012149:Restraint, Physical; D012189:Retrospective Studies; D016896:Treatment Outcome; D017410:Practice Guidelines as Topic
D000316:Adrenergic alpha-Agonists; D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D003000:Clonidine; D006220:Haloperidol; D008140:Lorazepam