I wanted to take a moment to highlight a 2019 QI project at NMH.
Alcohol use disorders is a common illness among hospitalized patients. A 2015 epidemiological study found the 12–month prevalence of alcohol use disorder among adults to be 13.9%.1 Identification of patients at high risk for complicated withdrawal (seizures, delirium tremens and severe alcohol withdrawal symptoms) is crucial to provide the appropriate treatment to patients. In addition, it also helps minimize unnecessary benzodiazepine use and undue strain on nursing staff by performing frequent CIWA questionnaires.
PAWSS is a validated one-time screening tool that has been demonstrated to identify those at high-risk for complicated alcohol withdrawal syndrome. A score greater or equal to 4 was demonstrated to have a specificity and sensitivity of 99.5% and 93.5% respectively. 2
As part of the QI project, the team in 2019 created a PAWSS order set that will reflex to CIWAs q4h for patients that score 4 or higher. Keep this easy-to-use order set in mind next time you have a patient you’re concerned for potential alcohol withdrawals.
Resources:
- Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015 Aug;72(8):757-66.
- Maldonado JR, Sher Y, Das S, Hills-Evans K, Frenklach A, Lolak S, Talley R, Neri E. Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome. Alcohol Alcohol. 2015 Sep;50(5):509-18.