Jersey City Medical Center alcohol withdrawal protocol was developed through shared governance councils, improving patient safety for trauma patients with alcohol use disorders.

Best Practice: The Alcohol Withdrawal Assessment and Management Protocol, Jersey City Medical Center, Jersey City, NJ

Jennifer Jones, DNP, RN, CNL, is the Trauma Program Director at Jersey City Medical Center, Jersey City, NJ, one of the few hospitals that is fully accredited in shared governance by the Forum for Shared Governance.

After witnessing several trauma patients suffer from alcohol withdrawal and delirium tremens while in the hospital, I assessed our current practices for managing patients with alcohol use disorders. I found that no screening or assessment tools were in use, nor were we following a medication protocol.

Developing the Protocol

I researched the most current evidence and developed a protocol that screens patients for alcohol use disorders and assesses withdrawal symptoms in those at high risk. Furthermore, with the help of a multidisciplinary Alcohol Withdrawal Task Force made up of physicians, pharmacists, and nurses, we created a medication management protocol. This protocol includes a symptom-triggered medication regimen that enables nurses to appropriately medicate patients based on their assessments from the Clinical Institute Withdrawal Assessment for Alcohol-Revised Scale (CIWA-Ar).

Shared Governance Council Input

The Alcohol Withdrawal Assessment and Management Protocol was then presented to both the Safety and Quality Council and the Professional Practice Council for their input. Members provided valuable feedback, especially regarding the implementation process. Notably, one of the councils suggested that protocol “super users” be trained to assist staff nurses during the early implementation phase. As a result, I trained the area Patient Care Coordinators as well as the Unit Nursing Educators in special sessions where we went over troubleshooting techniques in greater depth.

Implementation and Outcomes

Ultimately, all hospital nurses received education on the new protocol using a pre-test/post-test to demonstrate learning effectiveness. In addition, physicians, advanced practice providers, residents, and pharmacists also received training on the protocol. Once implemented, data was collected on trauma patients for a two-month period. While the sample size was not large enough to determine a statistically significant change, the results showed a reduction in the number of patients who experienced severe withdrawal symptoms, an improved adherence to the protocol by nursing staff, and no major complications from alcohol withdrawal, such as falls, seizures, or ICU/Intubation requirements.

The protocol remains in place at Jersey City Medical Center today. Moreover, a multidisciplinary team from all the RWJBH hospitals has been working over the past year to implement the protocol in each of the system’s acute care hospitals.