title: Improving alcohol withdrawal outcomes in acute care.
abstract: BACKGROUND
  Excessive alcohol consumption is the nation's third leading cause of preventable deaths. If untreated, 6% of alcohol-dependent patients experience alcohol withdrawal, with up to 10% of those experiencing delirium tremens (DT), when they stop drinking. Without routine screening, patients often experience DT without warning.
  
  
  OBJECTIVE
  Reduce the incidence of alcohol withdrawal advancing to DT, restraint use, and transfers to the intensive care unit (ICU) in patients with DT.
  
  
  METHODS
  In October 2009, the alcohol withdrawal team instituted a care management guideline used by all disciplines, which included tools for screening, assessment, and symptom management. Data were obtained from existing datasets for three quarters before and four quarters after implementation. Follow-up data were analyzed and showed a great deal of variability in transfers to the ICU and restraint use. Percentage of patients who developed DT showed a downward trend.
  
  
  METHODS
  Incidence of alcohol withdrawal advancing to DT and, in patients with DT, restraint use and transfers to the ICU.
  
  
  RESULTS
  Initial data revealed a decrease in percentage of patients with alcohol withdrawal who experienced DT (16.4%-12.9%). In patients with DT, restraint use decreased (60.4%-44.4%) and transfers to the ICU decreased (21.6%-15%). Follow-up data indicated a continued downward trend in patients with DT. Changes were not statistically significant. Restraint use and ICU transfers maintained postimplementation levels initially but returned to preimplementation levels by third quarter 2012.
  
  
  CONCLUSIONS
  Early identification of patients for potential alcohol withdrawal followed by a standardized treatment protocol using symptom-triggered dosing improved alcohol withdrawal management and outcomes.
authors.affiliation: Nurse Practitioner in the Stepdown Unit at Christiana Care Health System in Wilmington, DE. jmelson@christianacare.org.
authors.forename: Jo
authors.initials: J
authors.lastname: Melson
authors.affiliation: Medicine Outcomes Coordinator in the Performance Improvement Department at Christiana Care Health System in Newark, DE. mikane@christianacare.org.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kane
authors.affiliation: Research Facilitator for the Christiana Care Health System in Newark, DE. rmooney@christianacare.org.
authors.forename: Ruth
authors.initials: R
authors.lastname: Mooney
authors.affiliation: Nurse Practitioner with the Healthstar Physicians of Hot Springs, AR. polonius47@gmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Mcwilliams
authors.affiliation: Chief of the Division of Addiction Medicine for the Christiana Care Health System in Newark, DE. thorton@christianacare.org.
authors.forename: Terry
authors.initials: T
authors.lastname: Horton
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000517:prevention & control / Q000628:therapy*; D000437:Alcoholism; D002985:Clinical Protocols; D003422:Critical Care / Q000592:standards*; D000431:Ethanol / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008403:Mass Screening; D010360:Patient Transfer; D012149:Restraint, Physical; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000431:Ethanol