Abstract
Aims and methodA baseline audit of trainees' ability to recognise Wernicke's encephalopathy and initiate appropriate thiamine regimes in an in-patient alcohol detoxification unit was carried out. Based on the findings, gaps were addressed using targeted education and training, and their impact on improving standards of managing Wernicke's encephalopathy was re-audited.ResultsThe initial audit revealed that trainees' ability to recognise Wernicke's encephalopathy and initiate thiamine was inadequate. Significant improvement in appropriate use of treatment regime (P < 0.05) of thiamine and the monitoring of clinical response was observed after addressing the initial gaps through education.Clinical implicationsTreatment of Wernicke's encephalopathy can be inadequate, given a lack of awareness of clinical presentation and appropriate management. This can be addressed through education and training.
Highlights
Significant improvement in appropriate use of treatment regime (P50.05) of thiamine and the monitoring of clinical response was observed after addressing the initial gaps through education
We aimed to evaluate the impact of an educational intervention in improving recognition of Wernicke’s encephalopathy and practice of thiamine prescribing among these trainees using an audit
The audit was carried out in the alcohol detoxification ward of the Bradgate Mental Health Unit, Glenfield Hospital, Leicester. We focused on this group, as the rate of Wernicke’s encephalopathy is high among those with greater severity of alcohol dependence and potential interventions would have the highest impact in that group
Summary
We found that 15% (n = 2) of the patients in the pre-training period who met the criteria for Wernicke’s encephalopathy had ongoing monitoring of clinical signs to inform the treatment process, i.e. treatment discontinued if there was no clinical improvement. This increased in the post-training period to 68%. The ongoing monitoring of eye signs, confusion and ataxia following initiation of thiamine treatment regimes in the post-training sample provided an opportunity to record improvement on a daily basis.
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