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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CSI Toolkit

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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 materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

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.