IRB 15. 1874 implementation of an alcohol detoxification clinical pathway

Maureen Fowler

doi:10.17918/etd-6736

Approximately 1 in 5 medical patients have an underlying alcohol use disorder. Purpose: The purpose of this capstone project is to determine if standardization of the current clinical processes and assessment tools utilized for the alcohol withdrawal patient population contribute to improved patient outcomes as evidenced by a reduction in the overall cost to the organization in treating the substance abuse population on a non-psychiatric unit. Cost reduction will be measured by the number of transfers to a higher level of care and length of stay. Methods: The Symptom Management Theory Model was used as the framework for the project to facilitate timely patient assessment and interventions and to standardize the overall clinical management of the patient requiring alcohol detoxification. The symptom experience concept was the foundation for the development of a patient screening tool administered in the emergency department that requires the active participation of the patient and is utilized by providers to ensure timely interventions, prevent complications, and improve patient safety and care. Symptom experience includes vital signs, a history of alcohol withdrawal seizures or delirium tremens, and a history of required transfer to ICU in the past related to a complicated withdrawal. The symptom management concept was the foundation for the development of a standardized physician alcohol detoxification order set. Symptom management strategies include triage to the appropriate setting, early initial and ongoing patient assessment, and initiation of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) protocol and Moderate Detoxification Order Set. The symptom status outcomes concept was the foundation for evaluating the impact on transfers to a higher level of care, length of stay, development of alcohol withdrawal complications, restraint use, and patient aggression. Evaluation: To determine the effectiveness of the new program, a comparison of the patients treated with the new program for a six month period compared to those treated six months prior to program implementation will be conducted to evaluate the impact of implementing a new patient risk assessment, standardized Moderate Detox Order Set and a symptom-triggered (CIWA-Ar) approach on restraint usage, number of transfers to a higher level of care, and length of stay over a twelve month period. Recommendations: A standardized clinical process, assessment, and order set will improve the quality of care and decrease the associated cost of treating individuals requiring alcohol detoxification.

IRB 15. 1874 implementation of an alcohol detoxification clinical pathway

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IRB 15. 1874 implementation of an alcohol detoxification clinical pathway

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