Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal

Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal.

NRS-441V: Capstone Project

Writing Guidelines

Use the headings listed below and ensure that your papers contain the needed information for each section.

1) Abstract

a) Length is between 250-450 words.

b) Presents a complete, concise overview of all phases of the proposed project

c) Addresses a problem or issue related to patient care quality

d) References appropriate evidence-based literature; identifies at least one evidence-based solution that may resolve the problem or issue.

2) Problem Description

3) Solution Description

4) Implementation Plan

5) Evaluation Plan

6) Dissemination Plan

7) Review of Literature

8) Appendices

9) APA Style/Mechanics

10) APA format is used consistently in the proposal for the cover page, page header, margins, in-text citations, double-spacing, font size, and reference page.

a) Style is consistent with that expected of a formal project proposal.

b) The highest levels of evidence are used. (Note: Information from Web sites is not considered a professional reference source.)

c) At least 15 professional references (e.g., books, journal articles) are used to develop the proposal.

d) At least eight references are peer-reviewed and from quantitative or qualitative research study reports.

e) Text is free of grammatical, punctuation, typographical, and word-usage errors.

f) Project proposal is within word length requirements.

NRS-441V: Capstone Project

Exemplar of Evidence-Based Practice


Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal

(Student Name)(Grand Canyon University

(NRS 441V: Professional Capstone)

Instructor: (Name)



Based on documented studies, the prevalence of alcohol dependence in medical settings indicates that as many as 1 in 5 patients may require treatment for alcohol withdrawal (AW) while hospitalized for a concurrent illness. Research has indicated a definitive problem in recognizing and treating those patients at risk for AW. Symptom-triggered treatment, based on the use of appropriate assessment tools and treatment protocols, has been shown to be safe, and it is associated with a decrease in the quantity of medication required and the duration of treatment. Implementing standardized screening tools and initiating treatment based on established protocols, can prevent disease progression and an increased complication rate. These interventions can potentially decrease length of stay and health care costs.

Key words: alcohol withdrawal, assessment, CAGE, CIWA-Ar, symptom-triggered, protocol.

(Problem Statement- Module 1)

Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal

Patients admitted to the acute care setting with a secondary diagnosis of alcohol abuse carry a significant risk of alcohol withdrawal (AW) when there is a failure to recognize and treat their alcoholism. Early recognition of AW is essential to early intervention, which, in turn, has the potential to prevent or decrease serious complications associated with AW.

(Support from Literature Review- Module 2)

Alcohol withdrawal has been described as a syndrome that affects those people accustomed to regular alcohol intake, who suddenly stop drinking and subsequently develop those clinical manifestations associated with AW (Saitz, 1998). An estimated 15-20% of hospitalized patients are dependent on alcohol, putting them at risk for prolonged or complicated hospital stays (Lussier-Cushing, Repper-DeLisi, Mitchell, Lakatas, Mahmoud, & Lipkis-Orlando, 2007).

Dependence on alcohol usually remains undetected in the hospitalized patient until withdrawal signs appear, secondary to cessation of their alcohol intake. Nursing staff must recognize the warning signs and symptoms of AW. Without an established assessment process, it is difficult to predict withdrawal symptoms or assess risk factors associated with an increased severity of withdrawal symptoms and subsequent impact on the patient’s treatment plan. An established assessment process/protocol has the potential to reduce patient morbidity and mortality as well as health care costs.

One fifth of the total national expenditure for hospital care is related to alcohol dependence, as evidenced by prolonged hospital stays (particularly in the Intensive Care setting) and characterized by major complications for patients progressing through AW, with an increase in utilization of health care resources/services (Phillips, Haycock, & Boyle, 2006). In addition to the increase in required health care resources, patient and staff safety must be considered; consideration for the physical safety of the patient during a withdrawal episode and for the safety of the health care worker exposed to patient behaviors during a withdrawal episode is paramount. Further significant issues related to AW are found/indicated in the progression of symptoms during the course of AW including the increased use of restraints and the increased use of sitters during the progression period (Chaney & Gerard, 2003).

The determination of need for a program directed at identifying and addressing AW within a population should begin with retrospective chart audits of identified patients, and data collection related to cost and length of stay (LOS). Development of an audit tool for an initial risk assessment and the development of an ongoing assessment process should follow. Development of treatment protocols/interventions would be the final step in addressing the identification and treatment of the patient with AW.

Once the process has been developed and approved for implementation, initial and ongoing education for the administrative team, physicians, and nursing staff would be a priority. Updated summaries of program progress during a pilot period should be made available to administration, physicians, and staff alike.

One or more outcome measures should be initiated to determine success of the process. Quality monitoring and data collection through retrospective audits should be completed to determine compliance with the program, as well as the success of the patient assessment and intervention processes as determined by LOS and subsequent health care costs. Further quality monitoring could be obtained through subjective data collection related to patient and staff satisfaction.

Implementation (From Module 3 Plan)

Theories of health behavior and promotion play a decisive role in helping to improve health by directing plans and processes that assist in the identification of risk issues, the management of disease processes, the development of implementation processes, and the measurement of process outcomes. When addressing alcohol withdrawal (AW), referred to as Alcohol Withdrawal Syndrome in some literature, theory helps to understand why AW is problematic and/or a significant health care issue; to identify what information is required in addressing the identified problem and how to use that information; to define and/or develop the necessary changes and processes; and to define what and how to monitor and evaluate the change for outcomes.

(Incorporated Theory from Module 2)

There are two types of theory significant to the planning of health care, and to change in health care planning. Explanatory theory helps to identify why a problem exists and assists in the search for modifiable factors, while change theory guides the development of health promotion interventions (National Cancer Institute, 1998). Consideration of theory allows for review of research, in this case, related to AW and recognized interventions. Explanatory theory allows for focus on the problem of AW, its variables (i.e., co-morbidities, variations in clinical presentation, appropriate treatment); why it is a problem (i.e., increased severity of illness, increased health care costs); and what can be changed. Change theory is directed at improvement processes and helps to identify the strategies for process change (i.e., early identification and assessment of patients at risk for AW, appropriate interventions based on assessments) and makes assumptions related to the success of those interventions. These theories incorporate concepts that can be translated or developed into strategies, plans, and evaluations. The use of theory allows for a complete review and appraisal of available information related to AW, with appropriate emphasis on solutions and interventions. Theory also provides the basis for judging the appropriateness of those solutions and intervention through an evaluation process.

Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal

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