Journal article
A systematic nurse-led approach to withdrawal risk screening, prevention and treatment among inpatients with an alcohol use disorder in an ear, nose, throat and jaw surgery department-A formative evaluation.
- Leuenberger DL Department of Orthopaedic and Traumatology, Clinical Nurse Specialist, Inselspital, University Hospital Bern, Freiburgstrasse, CH-3010 Bern, Switzerland. Electronic address: deborah.leuenberger@insel.ch.
- Fierz K Institute of Nursing Science, Scientific Collaborator, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland. Electronic address: katharina.fierz@unibas.ch.
- Hinck A Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland; University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: andreas.hinck@usb.ch.
- Bodmer D Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland; University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: daniel.bodmer@usb.ch.
- Hasemann W Department of Nursing and Allied Health Professions, Practice Development Unit Nursing, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland. Electronic address: wolfgang.hasemann@usb.ch.
- 2017-01-19
Published in:
- Applied nursing research : ANR. - 2017
Alcohol use disorder
Assessment
Nursing
Adult
Aged
Alcoholism
Algorithms
Ear
Evaluation Studies as Topic
Female
Guideline Adherence
Humans
Male
Middle Aged
Nose
Orthognathic Surgical Procedures
Pharynx
Risk Assessment
Substance Withdrawal Syndrome
Surgery Department, Hospital
English
INTRODUCTION
Among patients with head and neck cancer comorbid alcohol use disorder is frequent which contributes to higher risk of developing perioperative alcohol withdrawal syndrome/delirium or delirium due to medical conditions. Although guidelines emphasize prevention and treatment of alcohol withdrawal in hospitalized patients, a validated systematic approach for management of these patients is still lacking. Our aim was to formatively evaluate our newly developed systematic approach in view of nurses' adherence to screening patients for regular alcohol consumption and managing their withdrawal symptoms using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised.
METHODS
We conducted a formative evaluation to improve the project's design and performance and used a retrospective chart review in a consecutive sample of all adult inpatients with head and neck cancer being assigned for surgery in a university hospital. Our bundle of interventions consisted of nurses' screenings for regular alcohol consumption, withdrawal risk assessment, offering patients a substitution therapy, nurses' assessments of withdrawal symptoms and symptom oriented withdrawal management. Proximate endpoints were analyzed descriptively at each component of the bundle in terms of frequencies and severity of withdrawal symptoms, frequencies of nurses' and doctors' screenings and nurses' assessments performed as required.
RESULTS
Between 2013 and 2014, 87 inpatients met inclusion criteria and screenings by doctors/ nurses revealed 49 alcohol consumers, where six screenings were omitted by nurses and six by doctors. Twenty-one consumers were at risk and six of them developed an alcohol withdrawal syndrome. None of the 87 showed an alcohol withdrawal delirium, but five developed a delirium due to medical conditions. Nurses correctly conducted all preventive elements of the intervention bundle in 14 (58%) patients at risk but overall, only performed 50% of the required assessments.
CONCLUSIONS
Although nurses safely managed patients' symptoms, nurses' adherence to the interventions was suboptimal and requires stronger leadership.
Among patients with head and neck cancer comorbid alcohol use disorder is frequent which contributes to higher risk of developing perioperative alcohol withdrawal syndrome/delirium or delirium due to medical conditions. Although guidelines emphasize prevention and treatment of alcohol withdrawal in hospitalized patients, a validated systematic approach for management of these patients is still lacking. Our aim was to formatively evaluate our newly developed systematic approach in view of nurses' adherence to screening patients for regular alcohol consumption and managing their withdrawal symptoms using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised.
METHODS
We conducted a formative evaluation to improve the project's design and performance and used a retrospective chart review in a consecutive sample of all adult inpatients with head and neck cancer being assigned for surgery in a university hospital. Our bundle of interventions consisted of nurses' screenings for regular alcohol consumption, withdrawal risk assessment, offering patients a substitution therapy, nurses' assessments of withdrawal symptoms and symptom oriented withdrawal management. Proximate endpoints were analyzed descriptively at each component of the bundle in terms of frequencies and severity of withdrawal symptoms, frequencies of nurses' and doctors' screenings and nurses' assessments performed as required.
RESULTS
Between 2013 and 2014, 87 inpatients met inclusion criteria and screenings by doctors/ nurses revealed 49 alcohol consumers, where six screenings were omitted by nurses and six by doctors. Twenty-one consumers were at risk and six of them developed an alcohol withdrawal syndrome. None of the 87 showed an alcohol withdrawal delirium, but five developed a delirium due to medical conditions. Nurses correctly conducted all preventive elements of the intervention bundle in 14 (58%) patients at risk but overall, only performed 50% of the required assessments.
CONCLUSIONS
Although nurses safely managed patients' symptoms, nurses' adherence to the interventions was suboptimal and requires stronger leadership.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.apnr.2016.11.013
- PMID 28096011
- Persistent URL
- https://sonar.ch/global/documents/278677
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