What's Your Alcohol Withdrawal Assessment Protocol?

[Meerkat]

We are having some trouble with ours, which is CAGE. The problem is that the initial orders say to administer the assessment if the pt answers YES to one or more CAGE questions. If the pt scores 10 or higher, call the doc and initiate Ativan dosing. BUT someone has to nearly be in DT's before they reach a 10. In other words, the scale does not allow for Ativan dosing if someone is SYMPTOMATIC but scoring less than 10. However, the next paragraph says "give one mg of Ativan if PT scores 6 to 9". We all got in trouble for med errors for dosing at 6 even though it is right there in black and white! The reasoning is that a score of 6 "IMPLIES" that you call the doctor for a specific order to dose at 6. Otherwise no Ativan til they score 10. Yesterday we had a detoxer with BP of 190/156 and couldn't give Ativan because she scored 8! Someone is going to throw a stroke if we have to wait that long to dose.

Isn't there a better protocol than CAGE? Admin says CAGE is national but I think they are pulling our collective leg.

[Antikigirl, ASN, RN]

OH this reminds me...of my patient of last week! And a warning to us all!

Okay..so an MD wanted this lady on a CIWA scale, but she didn't drink!!! A nurse before me told her the reason behind the questions...and I guess that is valid, but I actually do that as part of my assessment anyway...but anyhoo...oh man was she MAD!!!!!!!! I don't blame her!~

So she is actually sueing now for breach of patient rights...which she does have..she didn't know three times that she was actually going on treatment from the assessment! She had the right to refuse! Sad..and really she was really a down to earth lady!

Look at your hospital/facility protocols about this...do you let them know? Or do you just use this as part of assessment? (I treat pts by MD order on signs and symptoms..but...it is my discression!).

SHe will soooooooooooo win her case! Not to mention they violated a HIPPA in the meantime!