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 any patients with alcohol use disorders. I found that there was no screening or assessment tools being used, nor were we following a medication protocol.
I researched the most current evidence and developed a protocol that includes screening patients for alcohol use disorders and assessing for withdrawal symptoms in those patients at high risk for withdrawing. Further, with the help of a multidisciplinary Alcohol Withdrawal Task Force made up of physicians, pharmacists, and nurses, we created a medication management protocol that included a symptom-triggered medication regimen that would enable nurses to appropriately medicate patients based on their assessments from the Clinical Institute Withdrawal Assessment for Alcohol-Revised Scale (CIWA-Ar).
The Alcohol Withdrawal Assessment and Management Protocol was presented to both the Safety and Quality Council and the Professional Practice Council for their input. Members provided valuable feedback, especially for the implementation process. One of the councils suggested that protocol “super users” be trained to assist staff nurses in 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 a little more depth.
Ultimately all hospital nurses were educated on the new protocol using a pre-test/post-test to demonstrate learning effectiveness. Physicians, advanced practice providers, residents, and pharmacists were also educated on the protocol. When it was 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, there was 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, and 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.