Coffey Rebecca, Kulisek Janice, Tanda Rika, Chipps Esther
Burn Center, Ohio State University Health System, Columbus, OH 43210, USA.
Clin Nurse Spec. 2011 Nov-Dec;25(6):286-93. doi: 10.1097/NUR.0b013e318233ea75.
The purpose of this study was to determine the impact of implementation of evidence-based alcohol withdrawal syndrome (AWS) guideline using the Clinical Institute Withdrawal Assessment of Alcohol Scale--Revised scale on care and outcomes of burn patients with comorbid alcohol use and on physician and nurse documentation of alcohol screening, education, and referral.
A retrospective medical record review of burn patients (n = 428) was completed. Data were collected on admissions 1 year before implementation of the alcohol withdrawal guideline and 1 year after implementation. Data collection included alcohol use, use of benzodiazepines, sitter use, restraint use, total body surface area, inhalation injury, previous alcohol withdrawal, length of stay, and physician and nurse documentation.
A Midwestern academic medical center with an American Burn Association and the American College of Surgeons verified burn center.
A multidisciplinary team developed evidence-based practice guidelines for the treatment of AWS. Treatment of AWS was evaluated before and after implementation of the new guidelines.
Burn severity and inhalation injury were associated with patients at risk for alcohol abuse. There was no difference in the experience of alcohol withdrawal after guideline implementation. Documentation in the medical record of alcohol use, abuse, or previous withdrawal improved after implementation of the guideline.
Screening and treatment of alcohol abuse in the burn patient are still less than ideal.
Greater efforts should be directed at managing alcohol withdrawal. An advance practice nurse can make an important contribution.
本研究旨在确定使用修订版酒精戒断临床研究所评估量表实施基于证据的酒精戒断综合征（AWS）指南对合并酒精使用的烧伤患者的护理及结局，以及医生和护士对酒精筛查、教育及转诊记录的影响。
完成了对428例烧伤患者的回顾性病历审查。收集了酒精戒断指南实施前1年和实施后1年入院患者的数据。数据收集包括酒精使用情况、苯二氮䓬类药物使用情况、陪护使用情况、约束使用情况、烧伤总面积、吸入性损伤、既往酒精戒断情况、住院时间以及医生和护士的记录。
一家经美国烧伤协会和美国外科医师学会认证的中西部学术医疗中心的烧伤中心。
一个多学科团队制定了基于证据的AWS治疗实践指南。在新指南实施前后对AWS的治疗进行了评估。
烧伤严重程度和吸入性损伤与有酒精滥用风险的患者相关。指南实施后酒精戒断的经历没有差异。指南实施后，病历中关于酒精使用、滥用或既往戒断情况记录有所改善。
烧伤患者酒精滥用的筛查和治疗仍不尽如人意。
应加大对酒精戒断管理的力度。高级实践护士可做出重要贡献。
