Prevention and Therapy of

Alcohol Withdrawal
Elizabeth Beltran-Muoz, BSN, RN
Summer Gonzalez, BSN, RN
Ilse Hernandez, BSN, RN

O At University Medical Center of El Pasos Intensive Care Unit, patient

data was gathered from April 2015 to September 2015, and

approximately 25% of the patient population were admitted with an
alcohol related occurrence.
O With alcohol related occurrences, patients are at a higher risk of
experiencing alcohol withdrawals as evidenced by altered mental
status, agitation, seizures, diaphoresis, including delirium tremens.
O According to the Townsends DSM-V, (2014) delirium tremens is
defined as a rapid- onset fluctuating disturbance of attention and
cognition, sometimes with hallucinations (Townsend, C.M 6th edition,
2014, 286-287. )
O Evidence-based practice shows that 5% of patients who undergo
withdrawal from alcohol suffer from Delirium Tremens and is
associated with a mortality rate of up to 5% (Hoffman & Weinhouse,
2015.)

O Throughout our experience as new Registered Nurses, we have observed an

inconsistency in treatment regimens for those suffering from alcohol withdrawals.

As part of our Nurse Residency Program project, we would like to format a unit
policy creating a standardized protocol for the treatment of these individuals.

Timeline
October 2015:
Meetings set-up
with Eric Johansen
gathering data on
ED usage of CIWA
tool.

November 2015:
Questionnaire
created and
approved for ICU
nurses.

December 2015:
Gathering data from
ICU census (2
quarters) related to
Alcohol use.

January 2016:
Meeting with
Trauma/Surgery
and Medicine team
Attending
Physicians

February 2016:
Alcohol withdrawal
protocol created
with physicians
guidance.

February 2016:
Power Point
presentation being
created.
Critical Care
Committee Meeting

December 2015:
Folders created with
pertinent project
data to distribute to
physicians and
ICU/ER
management.

March 2016 :
Gathered additional
data

Service
Medicine

Age
58

April
Sex
M

Trauma

27

Trauma

65

Trauma

31

Medicine

29

50

M
May
Sex
M
M

Admission
4/19/201
5
4/26/201
5
4/13/201
5
3/12/201
5
4/02/201
5
4/01/201

5
Admission
4/11/201
5/05/2015
5

M
M

5/8/2015

Trauma

Service
Trauma
Medicine

Age
17
49

Trauma
Trauma

30

Trauma

70

5/2/2015

Medicine

40

5/9/2015

Medicine
Trauma
Medicine

52
38
38

M
M
M

5/14/2015
5/16/2015
5/5/2015

Trauma
Trauma

35

M
M

5/31/2015
5/20/2015

ICU
Patient
Census

Diagnosis
ETOH WITHDRAWAL X3 days;

MVC (+) ETOH

FOUND DOWN AT BAR; TBI
STAB WOUND, (+) ETOH
DTS HX: ETOH
FRONTAL SAH; HX:ETOH

Diagnosis
MVC ROLLOVER,
(+) ETOH&
UPPER
GI
CANNABIS BLEED; HX: ETOH
ABUSE, CIRRHOISIS
S/P FALL (+) ETOH
S/P MVC ; (+) ETOH &
COCAINE
S/P FALL (+ )LOC; HX: ETOH
ABUSE
HX: HTN, SEIZURES, DTs,
CIRROHSIS
ETOH WITHDRAWAL
S/P MVC (+) ETOH
UPPER GI BLEED, ETOH
ABUSE
S/P FOUND DOWN ,(+) ETOH
FOUND UNRESPONSIVE, (+)
ETOH

Service
Surgery

Age
29

June
Sex
M

Medicine

50

Medicine

40

Trauma

33

Trauma

22

Trauma

34

Medicine

39

Admission
6/7/2015

6/11/201
5
6/17/201
5
6/22/201
5
6/22/201
5
6/21/201
5
6/23/201
5

Diagnosis
ESOPHAGEAL TEAR, (+)
ETOH, METH, COCAINE &
MARIJUANA
S/P ASSUALT, SEVERE DTs

S/P FALL (+) ETOH AND DTs

FOUND DOWN (+) ETOH
MVA (+) LOC, (+) ETOH
MVC, (+) ETOH & COCAINE
ETOH WITHDRAWAL, DTs


Service
Medicine

Age
55

July
Sex
M

Medicine

51

Medicine

37

Trauma
Medicine

57
49

M
M

Trauma

43

Medicine

54

Trauma

26

Trauma

25

Trauma
Service

70
Age

August
M
Sex

Surgery

50

Trauma

76

Medicine

42

Trauma

52

Trauma

58

Admission
Diagnosis
7/30/201
(+) ETOH ABUSE, GI BLEED,
5
SEIZUREx1
7/20/201 UPPER GI BLEED, CIRRHOSIS,
5
ETOH
7/18/201
ETOH WITHDRAWAL
5
7/9/2015
FALL, ETOH
7/12/201
SEIZURES, DTs
5
7/15/201
S/P FALL, (+) ETOH,
5
SEIZURES
7/17/201
UPPER GI BLEED, SEIZURES,
5
DTs
7/13/201
MCC (+) ETOH,
5
7/12/201
MVC EJECTION, (+) ETOH
5

7/09/201
MVC EJECTION,
(+) ETOH
Admissio
Diagnosis
5
n
8/27/201
HX: ETOH ABUSE,
5
COMBATIVE, DTs
8/21/201
S/P FALL, ETOH ABUSE
5
8/04/201 UPPER GI BLEED, HX: ETOH,
5
CIRRHOSIS, ESOPHAGEAL
VARICES
8/22/201
FOUND DOWN, DTs
5
8/18/201
S/P FALL (+) ETOH
5

Age
61
45
65
45

Septemb
er
Sex
M
M
F
M

Admission
9/20/2015
9/22/2015
9/18/2015
9/22/2015

58
46
29

M
M
M

9/21/2015
9/23/2015
9/17/2015

Diagnosis
(+)ETOH, (+)LOC
HEP C, ETOH ABUSE
(+) ETOH, METH
CIRRHOSIS, HEP C, ETOH
ABUSE
ASSAULT, (+) ETOH
GI BLEED, HX: ETOH ABUSE
(+) ETOH & CANNABIS

Service
Trauma
Medicine
Trauma
Medicine
Trauma
Medicine
Medicine

14

ICU Alcohol-Related Admissions

12
10

10
8
6
4
2
0

10

7
5

ICU Survey Results

100
90
80
70
60
50
40
30
20
10
0

12
50
27
7

35
37

75
9

80

79
5

Trauma/Surgery Team Protocol

Medicine Team Protocol

References
OHoffman, R.S., & Weinhouse, G.L., (2015).

Management of moderate and severe alcohol

withdrawal syndromes. Retrieved from
http://www.uptodate.com/contents/managementof-moderate and-severe-alcohol-withdrawal-syndromes
OTownsend, C., M., (2014). Substance-related and
Addictive Disorders. Essentials of Psychiatric Mental
Health Nursing: Substance-Related and Addictive
Disorders (286-287). Philadelphia: F.A. Davis Company

Thank you for your support!