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Nurse-Driven Protocol: Managing Patients in Withdrawal

Maimonides Medical Center (Brooklyn, New York)

CSI Summary

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CSI Presentation

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Project Topic

Management of patients in alcohol/substance withdrawal

CSI Participants

Sharon Hawthorne, RN, BSN, CCRN
Ariadne Williams, RN, MSN, CCRN
Laurie Wilson, RN, MSN
Christina Ycaza-Gutierrez, RN, BSN, CCRN

Project Goals/Objectives

  1. To implement early recognition and management of symptoms of withdrawal using the Richmond Agitation Sedation Scale (RASS)
  2. To decrease the severity of withdrawal symptoms
  3. To decrease ventilator days
  4. To decrease complications (falls, injuries, VAP)
  5. To decrease the length of stay (LOS) in the MICU

Project Outcomes

  1. Achieved 100 percent RASS utilization
  2. Decreased average LOS in MICU 19 percent (1.3 days)
  3. Decreased average LOS in Maimonides Medical Center 27 percent (4.9 days)
  4. Decreased average ventilator days 25 percent (1.73 days)
  5. Decreased percentage of patients requiring a tracheostomy from 15.5 to 1.9 percent
  6. These outcomes resulted in a projected annual fiscal impact of $1,853,106.

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The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.