Alcohol Withdrawal Assessment Tool or Beer with meals?

[Mbshil]

I work on a Trauma Floor and we do not have a standing Alcohol Assessment Tool we use.Quite often we deal with homeless , alcoholic patients and when necessary we give Librium, Ativan per MD order.But it takes at times a while to get the MD's to order something etc. We also serve beer with meals at times.

How are you dealing with alcoholic patients in your faciltiy, and could you send me a copy of your assessment tool?

I am looking to develop an order set that is Nurses driven for our patients that are struggling with alcoholism.Any help would be great. Thanks to all!

[86toronado, BSN, RN]

We have a scoring tool, based on vital signs, and physical symptoms such as sweating, tremors, etc. Depending on the score, we give Ativan, 0.5-2mg every 2 hours. Call the MD for abnormally high scores, hold Ativan for low scores. I'm not at work, so I don't have the exact parameters, but it works pretty well, despite being a little bit of a PITA.

[XB9S, BSN, MSN, EdD, RN, APN]

We use CIWA for alcohol withdrawl

http://img.medscape.com/pi/emed/ckb/emergency_medicine/756148-812410-819502-1459954.pdf

http://www.ihs.gov/NonMedicalPrograms/NC4/Documents/AlcoholWithdrawalAssessmentSheets(PIMC%20Apr%2005).doc

[elkpark]

I am accustomed to using the CIWA scale with "sliding scale" benzos (plus the conventional vitamins).

[mamamerlee, LPN]

I remember when I worked somewhere with a high number of alcohol abuser that I learned not to ask 'how much do you drink?' but asked do you drink a case of beer every day? or a fifth of (whatever) every day. I got much better answers. Instead of 'a few beers' I heard 'a case every 2 days' or 'I usually buy 3 fifths every Friday'. This helped us know which people to watch out for.

[chelynn]

We use the CIWI scale

[SlightlyMental_RN]

For alcohol withdrawal, we use the CIWA scale.

[stellina615]

CIWA for ETOH withdrawal, and CINA for opiate withdrawal. PO Librium is typically what we use to detox ETOH patients, and it's pretty successful. I work on a second unit, where IV Ativan is the drug of choice for ETOH detoxers. It doesn't seem to be particularly effective, and a lot of times, in their attempts to calm the pt down, the nurses will give the Ativan Q2H until the pt hallucinates. I brought up my concerns with the efficacy of the IV Ativan and was told by another nurse that the hospital has a bigger profit margin with Ativan than with Librium...don't know if that's true, but I'm hoping not because that would be awful.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We use CIWA also.

[meandragonbrett]

I'm not sure what assessment scale we use...or if we even use one. Our ETOH DT protocol involves Ativan 1mg IV q15minutes PRN, 5mg Haldol IV/IM q1h PRN, and 2mg Ativan IV q6h. We also at times use precedex and propofol to get them through the DTs and then wake them up.

[nminodob]

Beer with meals? Is your facility in Europe or something?

That's funny, because I have always questioned why we are required to snow a pt with benzos to the point where they drift in and then out of somnolence for days all while being mostly in 5 pt restraints, when a tapering dose of ETOH would seem less of a physiological and psychological challenge to them. When ever I ask this question I am given the same answers: alcohol taxes their livers (as if benzos aren't metabolized through the liver), and that we are supposed to "correct" their substance abuse, not support it (again, as if benzos aren't abused substances as well). Has anyone seen any research on using alcohol instead of benzos?

I have read that benzos with short half-lives like lorazepam have fewer active metabolites and are preferred for w/d. But so many of our pts will detox and go out and resume their normal drinking pattern that it seems silly to adhere to a strict no-alcohol policy during the acute w/d stage.

[Meriwhen, ASN, BSN, MSN, RN]

In our alcohol withdrawal protocol we have standing orders for Librium q1h PRN, and our docs are pretty good about ordering us other drugs if we feel the patient needs them. I'm not sure what the name of our assessment tool is, but we use it (our checklist) q2h to monitor their progress.

We're a detox unit, so there is no Sam Adams served with dinner