Evaluation of a Web‐based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department. Issue 1 (20th November 2018)

• Record Type: Journal Article
• Authors: Thompson, Cameron; McLeod, Shelley L.; Perelman, Vsevolod; Lee, Shirley; Carver, Sally; Dear, Taylor; Borgundvaag, Bjug
• Editors: Cico, Stephen J.
• Is Part Of: AEM education and training. Volume 3:Issue 1(2019)
• Page Start: 50
• Page End: 57
• Publication Date: 2018-11-20
• Subjects: Emergency medicine -- Study and teaching -- Periodicals; Emergency medicine -- Study and teaching -- United States -- Periodicals; Periodicals; 616.025
• DOI: 10.1002/aet2.10202
• Languages: English
• ISSNs: 2472-5390

Abstract

Abstract: Background: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom‐driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol–Revised [CIWA‐Ar]) and treated according to severity. Accurate administration of the CIWA‐Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS. Methods: This was a three‐phase education program consisting of a series of e‐learning modules containing core competency material, an in‐person seminar to orient learners to high‐fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA‐Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA‐Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA‐Ar < 10) and failure to administer benzodiazepines when required (CIWA‐Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (take‐away bottle of four tablets) of benzodiazepine given were recorded. Results: Seventy‐four ED nurses completed the curriculum over an 8‐week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA‐Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (∆13.8%, 95% confidence interval [CI] = 9.3%–18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, ∆10 mg, 95% CI = 0–20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed. Conclusions: Completion of this curriculum resulted in better compliance with the CIWA‐Ar protocol by those who administer the CIWA‐Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.