Impact of the implementation of an alcohol withdrawal guideline on patients with burn injuries.

PURPOSE

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.

DESIGN

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.

SETTING

A Midwestern academic medical center with an American Burn Association and the American College of Surgeons verified burn center.

METHODS

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.

RESULTS

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.

CONCLUSION

Screening and treatment of alcohol abuse in the burn patient are still less than ideal.

IMPLICATIONS

Greater efforts should be directed at managing alcohol withdrawal. An advance practice nurse can make an important contribution.