Management of Alcohol Withdrawal Syndrome in the Emergency Department

This Doctor of Nursing Practice project involved development and approval of a clinical practice guideline (CPG) for management of alcohol withdrawal syndrome (AWS) in the emergency department (ED) of a large community trauma center in the southeastern United States. AWS is a common, potentially life-threatening condition requiring timely assessment and intervention to prevent. Variability in ED screening and treatment contributes to delayed intervention, increased rapid response activations, and intensive care transfers. The project purpose was to develop and obtain expert approval of an evidence-based CPG using the Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) tool to support standardized screening, symptom-triggered treatment, and disposition decisions. The practice-focused question asked whether a CIWA-Ar–based CPG would be approved by an expert panel for ED use. An interdisciplinary expert panel consisting of an ED physician, nurse leader, and an acute care practice specialist independently evaluated the guideline’s quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Quantitative AGREE II ratings were analyzed using descriptive statistics and qualitative feedback. Results demonstrated favorable ratings of greater than 96.3% across all six AGREE II domains with the guideline receiving a recommendation for use without modification. Implementation of the guideline has the potential to improve early recognition of AWS, reduce deterioration, intensive care transfers and promote high-quality care for a vulnerable population thereby contributing to positive social change.