The Implementation of CIWA-AR in the Emergency Department

Background Alcoholism effects 15.1 million adults ages 18 and older according to a 2015 National Survey on Drug Use and Health. In the emergency department (ED) alone, 62% of visits are attributed to alcohol and approximately 18-25% of patients admitted to the hospital develop alcohol withdrawal syndrome (AWS). Purpose The objective of this EBP project was to reduce the time to benzodiazepine administration for patients with AWS in the ED by introducing the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), a valid and reliable scale in its identification and treatment. Methods: Through a descriptive, quasi-experimental before and after design, total time to benzodiazepine administration was examined in patient groups before and after CIWA didactic education was delivered to nursing staff (n=130). Results 75.1% of ED nurses took the post-test and the average test scores increased by 43.8% and 44% at two ED in a Southern California Hospital. After didactic education, total time to benzodiazepine administration decreased from 62.48 minutes to 38.61 however this difference was not statistically significant. Analysis of time to benzodiazepines was limited to those patients scoring > eight on the CIWA scale. In this subgroup, the time increased from 19.0 to 42.1 minutes. Conclusions Barriers included survey fatigue, lack of physician buy-in, and inconsistency in documenting CIWA scores. Further studies are needed to explore barriers to timely administration.