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CIWA-Ar Protocol

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on 27 September 2015

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Transcript of CIWA-Ar Protocol

CIWA-Ar Protocol
Alexandra Klaahsen, OTS
How does CIWA-Ar Protocol effect therapy?
Benefits
Significantly small doses of medications (i.e. benzodiazepines) administered
Shorter duration of treatment
Shorter duration of hospitalization
Decreased adverse reactions
Clinical Institute Withdrawal Assessment of Alcohol - revised
Alcohol Withdrawal Symptoms
Autonomic hyperactivity
Increased hand tremor
Insomnia
Nausea or vomiting
Transient visual, tactile, or auditory hallucinations or illusions
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures
Symptom-Triggered Management
of Alcohol Withdrawal Syndrome
10 item survey assessing severity of alcohol withdrawal symptoms with scale of 0-67
ICD 9
291.81 - Alcohol withdrawal

ICD10
F10.239 - Alcohol withdrawal without perceptual disturbances
F10.232 - Alcohol withdrawal with perceptual disturbances
Nausea
and
Vomiting
0-7
Tactile Disturbances
0-7
Tremor
0-7
Auditory
Disturbances
0-7
Paroxymal
Sweats
0-7
Visual
Disturbances
0-7
Anxiety
0-7
Headache
0-7
Agitation
0-7
Orientation
0-4

A CIWA score below 9, no medication is needed
10-12 warrants 25 mg Chlordiazepoxide (Librium) or equivalent 1 mg Lorazepam (Ativan)
13-14 calls for 50 mg Chlordiazepoxide (Librium) or equivalent 2 mg Lorazepam (Ativan)
15-17 warrants for 75 mg Chlordiazepoxide (Librium) or equivalent 3 mg Lorazepam (Ativan)
18+ calls for 100 mg Chlordiazepoxide (Librium) or equivalent 4 mg Lorazepam (Ativan)
Medication Protocols
for Symptom Based Approaches
CIWA SCORE
<9: Mild Withdrawal
9-17: Moderate Withdrawal
18+: Severe Withdrawal
Evaluation and Treatment
Evaluate care of self and healthcare management (medications)
Evaluate cognition and its effect on functional performance
Relaxation techniques
Identification of positive occupations, which can facilitate positive coping skills
Connect patient with community resources to maintain change
(Solet, 2008)
Limitations
Increased burden on nursing staff due to time requirement and possible 1:1 staffing
Assessment takes 5-10 minutes to complete every 4-6 hours
Nurses require additional training on assessment
Turnover in nursing staff allows for decreased inter-rater reliability
Patient must be coherent enough to answer questions

QUESTIONS?
Every hour until score is less than 10 for 3 consecutive assessments, then every four hours

Full transcript