Ewolly

Hi guys, was just wondering on your thoughts of CIWA scoring patients with manipulative drug seeking behaviour. I work in A&E/acute medicine and we have several regular alcoholics who come to A&E for free diazepam on CIWA. Obviously CIWA has its place in DTs, seizures, etc but they know which new nurses they are able to mislead to get a false high score, then when a more experienced nurse who knows them refuses to hand out the diazepam on grounds they are being manipulative they start kicking off, shouting, swearing, demanding a Dr, etc. We usually only have inexperienced junior drs on a night shift who do not know these regular patients so assess them as agitated because they are withdrawing and prescribe diazepam, rather than the patient is agitated because they can't score free diazepam. Usually they self discharge when the diazepam stops. Sorry for the long post, how would you deal with these regulars who know how to play the system?