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!
We use the CIWA scale and we do serve beer with meals if needed as well. The CIWA will give anywhere form 1 - 5mg of Ativan on our protocol depending on how they score. If a CIWA scale that is not in the 'controlled' range for more than 1 check, the patients are shipped to ICU for more meds and further watching.
We give Ativan and/or Haldol for withdrawal. When the patient is transfered OUT of the ICU, their goal is to have a stable CIWA, and sometimes this is accomplished with a set dose (usually 2 - 5mg Ativan every 4 or 6 hours on TOP of a CIWA dose).
And just FYI - also on a Trauma floor on an Intermediate side of things.
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.
I'd venture to say the Ativan isn't the cause of the hallucinations, but more the withdrawal... I haven't heard of using librium / lithium for ETOH withdrawal, though, so the next time I work I'll have to ask the trauma folks what they think! How do you dose for ETOH withdrawal with these meds?
I'd venture to say the Ativan isn't the cause of the hallucinations, but more the withdrawal... I haven't heard of using librium / lithium for ETOH withdrawal, though, so the next time I work I'll have to ask the trauma folks what they think! How do you dose for ETOH withdrawal with these meds?
I'm not sure what you mean by "librium/lithium" in your comment. The two drugs are entirely different and have no connection to each other. Librium (chlordiazepoxide) is an older, short acting benzodiazepine that used to be used v. commonly for detox. You don't see it used as much as Ativan these days, but there's nothing particularly wrong with using it. Lithium carbonate is a mood stabilizer used as a front-line treatment of bipolar disorder. I've never heard anyone suggest that lithium has a role in alcohol detox.
I'm not sure what you mean by "librium/lithium" in your comment. The two drugs are entirely different and have no connection to each other. Librium (chlordiazepoxide) is an older, short acting benzodiazepine that used to be used v. commonly for detox. You don't see it used as much as Ativan these days, but there's nothing particularly wrong with using it. Lithium carbonate is a mood stabilizer used as a front-line treatment of bipolar disorder. I've never heard anyone suggest that lithium has a role in alcohol detox.
I must have been hallucinating but I thought I had seen somebody post that they give lithium to help with the withdrawals as well! Disregard
I must have been hallucinating but I thought I had seen somebody post that they give lithium to help with the withdrawals as well! Disregard
I think it's a common name confusion: whenever nurses float to our unit who aren't familiar with detox, they often call librium lithium. The regular staff makes sure they're set straight though :)
We use CIWA too but I did see a pt on our unit that could get 2 oz of vodka (drink of choice) Q 4? hrs. Pharmacy sent it up in small amber bottles and kept it in the Pyxis like any other med and it worked fairly well for this post op pt.
We had a patient one time that her drink of choice was either OJ and vodka or V8 and vodka (can't remember which). Her family had to bring it from home, and they were glad to do it. We solely keep beer for our patients, so it was either that or nothing.
If you notice I said Lithium and Librium b/c I thought I had saw both for some reason. Eyes playing tricks or something! That's why I was surprised when I saw it and the reason I commented on it hehe.
shiccy
379 Posts
We use the CIWA scale and we do serve beer with meals if needed as well. The CIWA will give anywhere form 1 - 5mg of Ativan on our protocol depending on how they score. If a CIWA scale that is not in the 'controlled' range for more than 1 check, the patients are shipped to ICU for more meds and further watching.
We give Ativan and/or Haldol for withdrawal. When the patient is transfered OUT of the ICU, their goal is to have a stable CIWA, and sometimes this is accomplished with a set dose (usually 2 - 5mg Ativan every 4 or 6 hours on TOP of a CIWA dose).
And just FYI - also on a Trauma floor on an Intermediate side of things.