Improving adherence to a severe alcohol withdrawal protocol through targeted order-set interventions

Introduction:

Evidence-based guidelines for the prevention or treatment of severe alcohol withdrawal syndrome (SAWS) in critically ill patients are currently lacking. Benzodiazepines (BZDs) are generally accepted as the cornerstone of therapy, while agents such as phenobarbital, propofol, or dexmedetomidine are reserved for BZD-refractory patients. Previous research at our community hospital indicated adjunctive therapies are often employed before adequate trials of BZDs have been administered.

Objectives:

To improve SAWS protocol adherence through targeted order-set interventions and healthcare provider education. Medication therapy received by patients with SAWS and admitted to the intensive care unit (ICU) will be documented after order-set interventions have been implemented to 1) compare medications administered before and after protocol implementation, and 2) evaluate dexmedetomidine usage before and after physician and nursing education.

Study Design:

Single-center, prospective, observational study with retrospective control group.

Methods:

Medical records of 66 patients admitted to the ICU at our hospital and treated for SAWS from August 2011 to October 2013 were reviewed in phase one data analysis. Patient’s hospital course, medication management, and sedation and agitation scores were documented. The SAWS protocol was then revised and education was provided to staff before the start of phase two. Phase two data collection will begin January 19, 2016 and will evaluate patients treated for SAWS according to the revised protocol. Phase two study participants will be compared with phase one participants to assess changes in prescribing practices, order-set adherence, and dexmedetomidine use.

Results:

Sixty-six patients were evaluated in phase one. Of those initial 66 patients, 35 (53%) received dexmedetomidine for SAWS. Of those who received dexmedetomidine, 21 (60%) did not receive concomitant BZDs during dexmedetomidine administration. Patients who received dexmedetomidine had longer ICU and hospital length of stay versus those who did not (9.8 vs. 3.9 day and 18.3 vs. 9.3 days, respectively).

Conclusions:

Expected completion May 31, 2016.