An Educational Intervention to Increase CIWA-Ar Effectiveness in the Inpatient Psychiatric Setting

Abstract

Purpose: This quality improvement project utilized an educational intervention to address inpatient psychiatric nursing staff’s knowledge, attitude, and confidence in caring for patients with alcohol detoxification using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). Background: Over 18 million Americans are currently diagnosed with alcohol use disorder (AUD). Up to 50% of people with AUD will develop alcohol withdrawal syndrome (AWS) secondary to cessation or gross reduction from typical alcohol consumption. The CIWA-Ar protocol, intended for patients with heavy alcohol consumption in the days leading to the admission, may be ordered at any time throughout a patient’s hospitalization. As a validated 10-item assessment tool, the CIWA-Ar considers anxiety, agitation, sensorium clouding, paroxysmal sweats, tremor, and auditory, visual, or tactile disturbances. The assessment typically takes about five minutes to complete, and results are used to guide and measure treatment effectiveness. Method: The quality improvement project was designed using the Model for Improvement and plan-do-study-act cycle. Psychiatric nurses were recruited to attend an in-person training or a synchronous, web-based education session that provided education on the effective use of the CIWA-Ar through local policy and evidence-based practices. Participants were invited to complete a post-test survey upon completing the educational intervention to measure perceived changes in knowledge, attitude, confidence, and intent to change practice. Results: Five participants attended the synchronous training session, including the behavioral health network director, two nursing staff, one case manager, and one psychiatric evaluator. Of these five, only two were eligible to participate in the study as they fit the inclusion criteria of being nurses who worked at the intervention site. Only one participant completed the post-test. The results demonstrated an increase in the participant’s knowledge, attitude, confidence, and intent to change practice. Conclusion: A key finding from the results was that the participant agreed that their knowledge, attitude, and confidence in caring for patients with alcohol detoxification using the CIWA-Ar had been enhanced after the educational intervention. The participant indicated a strong desire for an intention to change nursing practice. The successful project showcases the importance of CIWA-Ar training for nurses to enhance the effectiveness of the CIWA-Ar on one inpatient psychiatric unit.