1. Bahr, Sarah MSN, CS, APRN,BC
  2. Smith, Jeri MSN, ANP-BC, APNP

Article Content


The purpose was to improve the outcomes of patients undergoing alcohol withdrawal (AW) through implementation of theClinical Institute Withdrawal Assessment-Alcohol revised (CIWA-Ar). Research on AW supports standardizing care across practitioners by monitoring and using behavioral and pharmacological interventions.



Current management of AW compromises nursing's ability to provide quality care. As a result of providing standardized EB protocols, it is anticipated that outcomes will improve. Timely implementation will reduce delirium tremens, complications related to AW, and length of stay.



Currently, there is no consistent EB treatment for AW within the institution, rather patients receive various forms of alcohol treatment, including fixed-dosing, symptom triggered, and administration of alcohol to patients. The rationale for this protocol is to standardize assessment and treatment of patients experiencing AW based on research.



A CNS-led multidisciplinary team was charged to review current practices and outcomes, develop an EB protocol, and design an implementation process for AW. Based on the research findings, the protocol is symptom-triggered and includes CIWA-Ar scale and MD order set. Unit-based Quality Council is monitoring chosen quality and safety indicators on a pilot unit.



Primary outcome is standardization of care for patients undergoing AW based on research. Unit-based development councils are involved in staff education. Unit-based quality councils are involved in monitoring practice change. Implementation of the alcohol withdrawal protocol should result in (1) less medication utilization; (2) decreased incidence of delirium tremors, transfers to ICU, and length of stay; and (3)clinicians utilizing tool and accurately completing protocol.



Education and piloting of the CIWA-Ar protocol is occurring on a medical unit. Modifications to the protocol and institution-wide implementation will be based on the results of pilot data.


Implications for Practice:

Close monitoring is critical in providing protection for the patient and for obtaining accurate information to guide clinical decision making. The implementation of the CIWA-Ar assists in standardizing care across a highly complex healthcare delivery system in a timely manner. It ensures best practice and improved patient outcomes in patients experiencing AW.