Management of the alcohol withdrawal syndrome at Canberra Hospital Alcohol and Drug Service: a best practice implementation project

Abstract

BACKGROUND Within specialist withdrawal units, alcohol withdrawal syndrome is easily predicted, assessed, monitored and treated as it is the principle reason for admission. In the acute care setting it may be the primary or secondary reason for admission, and may initially go undetected and untreated until the withdrawal syndrome becomes severe. This clinical audit project commenced in October 2013 and was completed in March 2014 in acute care settings in the Canberra Hospital, by the Alcohol and Drug Consultation Liaison Service. OBJECTIVES The aim of this project was to ensure accurate management of alcohol withdrawal syndrome, across two diverse acute care settings, promoting best practice symptom triggered pharmacotherapy administration. An audit of alcohol withdrawal management documentation to ensure best practice standards was completed. An adjunct to this was to increase awareness of appropriate referral processes to Consultation Liaison Alcohol and Drug Service from the acute care setting. METHODS The project utilized the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice online audit tool for promoting change in health practice. Data collection was prolonged due to requiring training to access electronic patient records. Training was completed and 20 electronic patient clinical files, addressing alcohol withdrawal management, were reviewed against 5 audit criteria. This baseline audit was conducted across two diverse clinical areas. Planned education sessions, discussion with clinical leaders and a streamlined referral form were implemented in an attempt to improve practice and reduce patient risk of a more complicated withdrawal syndrome. Follow-up clinical audit reviewing 20 different patient files was conducted to assess for improved practice and adherence to procedure. RESULTS The follow-up audit demonstrated a variation in compliance across the two clinical areas. Clinical area A had a lower baseline, but showed the greatest improvement in compliance for the most part of the audit criteria. Clinical area B had a higher baseline but showed poorer compliance in the follow up audit. CONCLUSIONS This project has demonstrated that providing a best practice framework for alcohol withdrawal syndrome in the form of standard operating procedures is vital in acute care settings. There is variation in clinician knowledge of this issue and further difficulties arise when the syndrome is unexpected. The alcohol withdrawal syndrome is self-limiting, and an understanding of this and of the alcohol withdrawal scale is vital in guiding medical management and preventing further complications. The ongoing priority is to ensure clinicians know how to refer to Alcohol and Drug Consultation and Liaison Service, as an early referral reduces risk.