1. Special Appreciation:
Reducing Hospital Acquired Conditions through the Appropriate use of Exhibit Clinical Indications Withdrawal of Alcohol Protocol
Barry Gallison, Vera Bloomston, Barbara Donnelly, Joanne Hendee, Joan Osborne, Sandra Todd-Atkinson, Kim Cerri, Jennifer Kelly & Paul Dube
Purpose
Hypothesis
Results
Implications
The purpose of the performance improvement project was to offer recommendations for the consistent practices in the management of alcohol abuse patients.
By implementing a Clinical Indications Withdrawal of Alcohol (CIWA) Protocol standardization of care would improve clinical outcomes. .
The implementation of the CIWA protocol assists in standardizing care & empowers nurses to be active in the management of the patients with high risk for alcohol withdrawal improving outcomes & reducing hospital acquired conditions.
Nurses utilizing a CIWA protocol will consistently manage patients with
geriatric, psychiatric alcohol abuse issues resulting in a decrease in
companion utilization, physical restraints, employee injuries & falls.
Nurses utilizing a CIWA protocol will consistently manage patients with
geriatric, psychiatric alcohol abuse issues resulting in a decrease in:
sitter utilization
physical restraints
employee injuries
patient falls
(Figure 9)
Sitter Hours as % of Patient Days
Restraint Use as % of Patient Days
Implementation
Strategy
Explored & introduced evidence-based CIWA protocols.
Collaborated with the Psychiatric Medical Director to develop & implement a CIWA protocol.
Developed, trialed, modified & implemented a Sitter Risk Assessment tool.
Revised sitter role & responsibilities job description.
Collected, tracked & trended data to monitor progress.
To understand the scope of the existing problem with the management of alcohol abuse patients the team conducted a
comprehensive literature review,
constructed a fishbone diagram & brainstormed.
The team analyzed historical data to identify areas of opportunity for improvement in caring for this population, including:
long hospital stays
excessive falls
restraints
sitters
employee injuries
Literature review
Boltz, M. (2006). Wandering and Elopement: A Comprehensive Approach. Assisted Living Consult. Sept/Oct,
Boswell, DJ, Ramsey, J. Smith, MA & Wagers, B. (2001). The cost-effectiveness of a patient-sitter program in an acute care hospital: A test of the impact of sitters on the incidence of falls and patient satisfaction. Quality Management in Health Care, 10(1),
Harding, AD. (2010). Observation assistants: Sitter Effectiveness and Industry Measures. Nursing Economics, 28(5):
Tzeng, HM, Yin, CY & Grunawalt, J. (2008). Effective assessment of use of sitters by nurses in inpatient care settings. Journal of Advanced Nursing, 64(2),
Assaults to Staff (rate)
Evaluation
After implementing the CIWA protocol, the hospital has experienced a reduction of 2.42% sitter hours, 0.83% restraints, 0.6% employee injuries & an essentially flat fall rate.
Special Appreciation:
Alice Taylor, CEO
Aldo Morales, MD
Falls (rate)