Help with CIWA & RASS

[JustAdmitToObs]

May be a dumb question but can't find anything within my organization policies or even google that answers it.

The paper form my organization uses to score a CIWA assessment has you total your CIWA score at the bottom and mark the RASS score below it. No further calculations of those 2 numbers are prompted.

It seems that it makes some sense to subtract the RASS score from the CIWA score in determining how to medicate and making sure you don't over-medicate. For example, say your patient has a CIWA score of 5 but is drowsy and has a RASS score of -1. Would you make the total score 4 and thus not give the med ordered for CIWA score of 5-7?

If this is not the case, what is the point of the RASS assessment?

[Triddin]

So I'll give you my take, but understand I don't have access to your hospital policies so refer to those when determining how to medicate a patient.

RASS only measures consciousness whereas CIWA is more specific to alcohol withdrawal. I don't think it's wrong to assess both at once, but I wouldn't subtract RASS from ciwa unless that is what your hospital specified

[LovingLife123]

CIWA is alcohol withdrawal. RASS is the scape you use to measure sedation, like with an intubate patient and you have them on a sedating medication such as propofol.

They measure two separate things. You would not subtract numbers at all.

[canoehead, BSN, RN]

My CIWA scale is very subjective. So if the patient tells you they are hearing things, is nauseated and has a headache, but you cant see it objectively, how high do you score? Some patients want to maximize the amount of prns they can get and end up gorked.

[Guest219794]

Separate issues.

Assess CIWA, and medicate according to protocol.

Not sure where RASS comes in. Is the thought that somebody with a high CIWA might already be oversedated?

Somebody with a RASS of 0 or below is not likely to score high enough on CIWA to medicate. I am guessing whoever linked these two assesments does not understand either.

FWIW, I find CIWA, in many cases, to be pretty worthless. There is a process in testing called "norming". In that process, professionals with similar backgrounds should essentially score identically or similarly. There is no way CIWA meets that metric. The amount of subjectivity from both the nurse and the PT is huge.

Personally, I try and figure out how much medicine they need based on my nursing judgement and experience. Amazingly, if they need 2 mg ativan, their CIWa is whatever number results in me giving 2 MG ativan.