Efficacy of a Symptom-Triggered Practice Guideline for Managing Alcohol Withdrawal Syndrome in an Academic Medical Center

Stanley, Karen M.; Worrall, Cathy L.; Lunsford, Shayna L.; Couillard, Deborah J.; Norcross, E. Douglas

doi:10.1080/10884600701699255

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Prior studies in AWS management have established the superior effectiveness of symptom-triggered AWS protocols over fixed-dose tapering (or provider preference) in reducing AWS-related complications including DT, need for intubation, and escalation in care to an IMU or ICU. [14][15][16] Other studies have also demonstrated the effectiveness of symptom-driven approaches to decrease the length of hospitalization, 15,17,18 lower the required benzodiazepine exposure necessary to treat AWS, 7,12,15,[17][18][19][20][21][22][23][24][25][26][27][28] and reduce the duration of treatment with benzodiazepine sedation. 7,12,[22][23][24][25][26][27]29 Although there are other effective validated indices described in the literature, 29 the CIWA-ar remains one of the most widely accepted.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a modified MINDS‐based protocol for management of alcohol withdrawal syndrome on an inpatient medical service

Krcmarik,

Hulley,

Huang

et al. 2023

Pharmacotherapy

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ObjectiveTo determine if a novel symptom‐based alcohol withdrawal syndrome (AWS) protocol in a US Veterans cohort leads to significant clinical improvements in patient outcomes and safety.BackgroundPrior studies of AWS management, oftentimes using the revised version of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA‐Ar) index, have demonstrated the effectiveness of symptom‐triggered therapy for AWS. The Minnesota Detoxification Scale (MINDS) is an alternative to the CIWA‐Ar index but remains unevaluated outside of the intensive care unit (ICU) setting. This study assesses outcomes in AWS management prior to and after the implementation of a novel MINDS‐based AWS protocol (SDAWP) utilizing a revised MINDS index (MINDS‐rev) in an inpatient medical ward setting.MethodsRetrospective cohort study including encounters prior to (n = 342) and after (n = 338) the implementation of the protocol. Pre‐ and post‐protocol encounters were selected by combinations of diagnostic codes and charting elements. Outcome measures of AWS management were obtained in both groups. The primary endpoint was median total benzodiazepine exposure. Secondary outcomes included median length of hospitalization, median duration of benzodiazepine administration, and the incidence of complications.ResultsThe median total benzodiazepine exposure in the post‐SDAWP group was significantly lower than the pre‐SDAWP group (21.2 vs. 12.0 mg, p < 0.0001) and for a significantly shorter median duration of time (4.0 vs. 3.0 days, p < 0.0001). There was no significant difference in the median length of stay (4.0 vs. 4.0 days, p = 0.50). The incidence of delirium tremens (21 vs. 7, p = 0.01) and need for transfer to a higher level of care (33 vs. 12, p = 0.002) was significantly lower in the post‐SDAWP group.ConclusionThe SDAWP has provided significant improvements in AWS management in our institution and may potentially serve as a template for wider use in other inpatient settings.

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Section: Discussionmentioning

confidence: 99%

Assessment of a modified MINDS‐based protocol for management of alcohol withdrawal syndrome on an inpatient medical service

Krcmarik,

Hulley,

Huang

et al. 2023

Pharmacotherapy

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“…[6,10,14,22] As such, it is important for nurses to consider less expensive interventions that have demonstrated success in preventing harm such as symptom triggered protocols, staff education, and video monitoring. [9] The intervention implemented in the hospital where the current study was performed, was engaged to decrease the use of sitters in the study hospital was video monitoring.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of patient sitters with video monitoring versus in-room sitters

Davis

Kutash²,

Whyte³

2016

JNEP

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Background/Objective: Use of in-room sitters to prevent patient's fall or injury is widespread in hospitals. This practice, however, is expensive, seldom reimbursed, controversial in the literature, and not supported by a strong body of evidence. The objective of this study was to determine the prevalence of patient falls and self-harm using in-room sitters and video monitoring and associated costs. Methods: In-room sitters and video monitoring was studied in two adult, medical surgical units, using an evaluative research design, with quasi-experimental approach. Descriptive statistics and independent samples t tests were performed for analysis. Results: The study identified no statistically significant difference in the prevalence of falls or self-harm events when video monitoring was used to provide constant observation. There was statistically significant lower cost per patient day with video monitoring. Conclusions: Video monitoring is less expensive than sitters and does not impose a patient safety risk for falls or self-harm.

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Alcohol Detoxification

Rubio

Ponce

2013

Interventions for Addiction

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Efficacy of a Symptom-Triggered Practice Guideline for Managing Alcohol Withdrawal Syndrome in an Academic Medical Center

Cited by 4 publications

References 10 publications

Assessment of a modified MINDS‐based protocol for management of alcohol withdrawal syndrome on an inpatient medical service

Assessment of a modified MINDS‐based protocol for management of alcohol withdrawal syndrome on an inpatient medical service

A comparative study of patient sitters with video monitoring versus in-room sitters

Alcohol Detoxification

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