Audit on the Adherence to Guidelines for the Management of Alcohol Withdrawal Syndrome in a General Hospital

Abstract

Aims

Problematic drinking of alcohol is a common problem in the United Kingdom. As alcohol is a central nervous system (CNS) suppressant, when a chronic user abruptly stops drinking alcohol, the alcohol-mediated CNS inhibition is withdrawn and the glutamate-mediated CNS excitation is left unchecked leading to a total excitation of the CNS. This results in alcohol withdrawal syndrome (AWS). The aim of this audit was to assess the compliance to the health board's policy for management of AWS available in the intranet as NU16 which was developed based on the NICE guidelines, across the wards in the General hospital. We aimed to assess compliance concerning four aspects:

1. 1. Initial clinical and laboratory assessment

2. 2. Prescribing for alcohol detoxification (benzodiazepines and vitamins)

3. 3. Scoring of and adherence to CIWA-Ar

4. 4. Specialist advice during the admission

Methods

We requested for the case records of patients admitted to the Wrexham Maelor Hospital during May 2022 with problematic alcohol consumption. We have received 56 case notes from the medical records department among which, 50 fulfilled the inclusion criteria. A case report form was prepared based on the NU16 and anonymized data were collected.

Results

Average age of the participants was 56 years ranging from 21 to 95.There were 29 males and 21 females. Mean days in the hospital was 3.25(+0.88). Only 4% of the records had complete documentation of drinking history, 84% had documentation of physical examination, and 20% had the documentation of signs of Wernicke's encephalopathy. CIWA-Ar was applied in 44% with correct scoring only in 24%. Compliance to laboratory investigations varied from 16% for gamma glutamyl transferase (GGT) to 84% for full blood count. Benzodiazepines were prescribed for 38%, oral thiamine was prescribed for 58%, 42% had two pairs of intravenous pabrinex three times a day and 6% had received 1 pair once a day. Benzodiazepine regimen was completed in 75% and alcohol liaison opinion was obtained only in 16%

Conclusion

We could find that there were omissions in multiple areas of adherence to the guidelines in all the four domains. Alcohol liaison team is conducting special training programs for the management of AWS for all the clinical staff in the general hospital with the aim that compliance should improve in the near future.