Evaluation of a Web‐based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department

Abstract

Background: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom-driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised [CIWA-Ar]) and treated according to severity. Accurate administration of the CIWA-Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS.Methods: This was a three-phase education program consisting of a series of e-learning modules containing core competency material, an in-person seminar to orient learners to high-fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA-Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA-Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA-Ar < 10) and failure to administer benzodiazepines when required (CIWA-Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (takeaway bottle of four tablets) of benzodiazepine given were recorded.Results: Seventy-four ED nurses completed the curriculum over an 8-week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA-Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (Δ13.8%, 95% confidence interval [CI] = 9.3%-18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, Δ10 mg, 95% CI = 0-20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed.Conclusions: Completion of this curriculum resulted in better compliance with the CIWA-Ar protocol by those who administer the CIWA-Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.

Use of a Novel Standardized Administration Protocol Reduces Agitation Pro Re Nata (PRN) Medication Requirements: The Birmingham Agitation Management (BAM) Initiative

“…42,43 Effectiveness of both the BAM and CIWA-Ar protocols may be limited, however, by nursing training and acceptance. [44][45][46] In addition, subjectivity of the scaled items may still present a problem (ie, defining "boisterousness" on the BVC, or "moderate" versus "severe" tactile disturbances on the CIWA-Ar). 47 Frequent input from the treatment team with judicious use of these protocols may enhance their overall effectiveness.…”

Development and evaluation of an e-learning course in oxygen therapy

“…So far, a number of online courses, such as online training module for identifying and treating human trafficking victims [30], managing circulatory shock [31], identifying and managing alcohol withdrawal [32], interpreting electrocardiograms (ECGs) [33], and using manual defibrillators in cardiopulmonary resuscitation [34] have been developed for ED staff. However, few courses are related to the field of oxygen therapy.…”