Presentation on theme: "Utilizing the Adult Alcohol Withdrawal Syndrome Order form & CIWA-Ar tool Prepared by Buffalo General Hospital Departments of Pharmacy and Clinical."— Presentation transcript:
1 Utilizing the Adult Alcohol Withdrawal Syndrome Order form & CIWA-Ar tool Prepared by Buffalo General Hospital Departments of Pharmacy and Clinical Education April 2010
2 Alcohol Withdrawal Syndrome (AWS) Definition: discontinuation or reduction of prolonged, heavy alcohol use that results in minor or major withdrawal symptoms.Minor withdrawal symptoms include: tremor, hypertension, diaphoresis and tachycardia.Symptoms can occur within 6-12 hours from last drink.Serious withdrawal complications include: seizures and delirium tremens (DTs).Symptoms can occur within hours from last drink.Severity of symptoms is related to amount of alcohol intake and duration of patient’s recent drinking habit.
3 Clinical Institute Withdrawal Assessment for Alcohol Scale, revised (CIWA-Ar) This assessment scale:Objectively assesses patients for the development of acute alcohol withdrawal.Has well-documented reliability and validity.Is a 10-item scale that assesses the severity of withdrawal.Serves as a basis for prescribing medication management.
4 CIWA-Ar This 10-item scale can be located in 2 places: On the back of the order form (requires addition calculation)orby using an online CIWA-Ar calculator that can be placed on a computer desktop.The 10 items to be assessed are:Nausea & vomiting Visual disturbancesHeadache, fullness in head AgitationParoxysmal sweats Tactile disturbancesAuditory disturbances TremorAnxiety Orientation & cloudingof sensorium
10 CIWA-Ar Documentation Prescriber to fill in first CIWA-Ar score in “Monitoring” section.Prescriber will check the desired protocol in the table.
11 CIWA-Ar Calculation and Documentation Registered Nurse must obtain all subsequent CIWA-Ar scores and document in “Alteration in Neurological Status” section of the “Adult Patient Plan of Care Record” (write in on blank line)Frequency of patient assessment and scoring is dictated by the protocol table at bottom of the order form.CIWA-Ar Score3
12 CIWA-Ar Online Calculator* *Note: check your desktop on WOWs FIRST…the CIWA- Ar calculator icon may already be there!Available from “UpToDate” and can be placed on computer desktop by following these steps:Go to “Kaleidascope” home pageClick on “Applications” tabClick on “UpToDate.com” then enter “UpToDate.com” button then “Accept” buttonClick on “Calculators” tabClick on “Primary Care Calculators”Right click on “Calculator: CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol Scale” and select “Copy Shortcut”Go to desktop and right click in blank area and select “Paste Shortcut”
13 Frequency of Assessing CIWA-Ar Score Frequency of score depends on current CIWA-Ar* score:If score is 1-9: repeat score q4h while awake,until score is less than 10 for 24 hours;then repeat score q8h for 48 hoursIf score is 10-15: repeat score q2hIf score is 16-20: repeat score q2hIf score is greater than 20: repeat score q1h or as clinically indicated along with vital signs.* Higher Score indicates more severe symptoms, necessitating more frequent patient assessment
14 Duration of Order SetThe protocol is to be discontinued when the CIWA-Ar score has been less than 10 for 72 hours.
15 Scenario 1-Introduction A 47 year old male is admitted with diagnosis of cellulitis.The Adult Alcohol Withdrawal Syndrome Orders were initiated- and the Lorazepam protocol was selected based on his symptoms and history.Patient Assessment:is awake, alert & oriented X 3complains of being a little nauseous but has not vomitedhas a very mild headachefeels a little anxiousThe patient does not have:any visual, auditory or tactile disturbances;paroxysmal sweatsagitationortremors.The patient states he drinks approximately 2-3 beers/day.
16 Scenario 1 (continued)Use this chart to determine his CIWA-Ar Score.
18 Scenario 1-continued What medication should be administered? When should the CIWA-Ar score be repeated?
19 Scenario 1 answers What is his CIWA-Ar Score? 3 What medication should he receive?No medication necessaryWhen should the CIWA-Ar Score be repeated?Every 4 hours while awake
20 Scenario 28 hours later the patient is still awake, alert & oriented x 3 and has the following:Intermittent nausea with dry heavesModerate headacheSweat seen on foreheadModerately anxiousModerately fidgetySevere tremors even without arms being extendedPatient does not have auditory, visual or tactile disturbances
21 Scenario 2-continuedWhat is the patient’s CIWA-Ar score now?
22 Scenario 2-What is his CIWA-Ar Score now? Answer=26
23 Scenario 2-continued What medication should be administered? When should the CIWA-Ar score be repeated?Should any additional interventions be initiated?
24 Scenario 2 (answers) What is his CIWA-Ar Score now? 26 What medication should he receive?Lorazepam 3mg po NOW and every 1 hour as neededWhen should the CIWA-Ar Score be repeated?Every hour along with vital signsShould any additional interventions be initiated?Yes, contact prescriber to evaluate; document assessment and interventions in patient’s chart
25 Conclusion The CIWA-Ar scale is a very useful tool to: Measure severity of withdrawal symptomsGuide medication administration based on severity of symptomsAssure patient safety during withdrawal