title: A systematic nurse-led approach to withdrawal risk screening, prevention and treatment among inpatients with an alcohol use disorder in an ear, nose, throat and jaw surgery department-A formative evaluation.
abstract: Among patients with head and neck cancer comorbid alcohol use disorder is frequent which contributes to higher risk of developing perioperative alcohol withdrawal syndrome/delirium or delirium due to medical conditions. Although guidelines emphasize prevention and treatment of alcohol withdrawal in hospitalized patients, a validated systematic approach for management of these patients is still lacking. Our aim was to formatively evaluate our newly developed systematic approach in view of nurses' adherence to screening patients for regular alcohol consumption and managing their withdrawal symptoms using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised.
  
  
  
  We conducted a formative evaluation to improve the project's design and performance and used a retrospective chart review in a consecutive sample of all adult inpatients with head and neck cancer being assigned for surgery in a university hospital. Our bundle of interventions consisted of nurses' screenings for regular alcohol consumption, withdrawal risk assessment, offering patients a substitution therapy, nurses' assessments of withdrawal symptoms and symptom oriented withdrawal management. Proximate endpoints were analyzed descriptively at each component of the bundle in terms of frequencies and severity of withdrawal symptoms, frequencies of nurses' and doctors' screenings and nurses' assessments performed as required.
  
  
  
  Between 2013 and 2014, 87 inpatients met inclusion criteria and screenings by doctors/ nurses revealed 49 alcohol consumers, where six screenings were omitted by nurses and six by doctors. Twenty-one consumers were at risk and six of them developed an alcohol withdrawal syndrome. None of the 87 showed an alcohol withdrawal delirium, but five developed a delirium due to medical conditions. Nurses correctly conducted all preventive elements of the intervention bundle in 14 (58%) patients at risk but overall, only performed 50% of the required assessments.
  
  
  
  Although nurses safely managed patients' symptoms, nurses' adherence to the interventions was suboptimal and requires stronger leadership.
authors.affiliation: Department of Orthopaedic and Traumatology, Clinical Nurse Specialist, Inselspital, University Hospital Bern, Freiburgstrasse, CH-3010 Bern, Switzerland. Electronic address: deborah.leuenberger@insel.ch.
authors.forename: Deborah Linda
authors.initials: DL
authors.lastname: Leuenberger
authors.affiliation: Institute of Nursing Science, Scientific Collaborator, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland. Electronic address: katharina.fierz@unibas.ch.
authors.forename: Katharina
authors.initials: K
authors.lastname: Fierz
authors.affiliation: Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland; University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: andreas.hinck@usb.ch.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hinck
authors.affiliation: Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland; University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: daniel.bodmer@usb.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bodmer
authors.affiliation: Department of Nursing and Allied Health Professions, Practice Development Unit Nursing, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland. Electronic address: wolfgang.hasemann@usb.ch.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hasemann
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000451:nursing*; D000465:Algorithms; D004423:Ear / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery; D056948:Orthognathic Surgical Procedures; D010614:Pharynx / Q000601:surgery; D018570:Risk Assessment; D013375:Substance Withdrawal Syndrome / Q000451:nursing*; D013503:Surgery Department, Hospital
keywords: Alcohol use disorder; Assessment; Nursing