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2 results on '"ACUTE ALCOHOL WITHDRAWAL"'

1. OC-030 Benefits of introduction of a symptom triggered regimen for management of alcohol withdrawal in a large teaching hospital trust: reduced admission duration and cost savings

Author

M Samuel, H Rutherford, Eilish Gilvarry, Christian Dipper, T J W Lee, L Bewick, P Perez, Steven Masson, and M Cunningham

Subjects
Benzodiazepine, medicine.medical_specialty, medicine.drug_class, business.industry, Specialist nurse, Gastroenterology, Nice, ACUTE ALCOHOL WITHDRAWAL, Cost savings, Chlordiazepoxide, Surgery, Teaching hospital, Regimen, Emergency medicine, medicine, business, computer, medicine.drug, computer.programming_language
Abstract

Introduction Acute alcohol withdrawal (AAW) is an increasingly frequent cause for hospital admission in the UK. NICE guidance (2010) recommends the use of a symptom triggered regimen (STR) rather than a fixed-dose regimen of benzodiazepines for the management of AAW. The aim of this study is to observe the effects of the introduction of a STR protocol as part of the introduction of a specialist Alcohol Liaison Team (ALT) in a large teaching hospital trust. Methods Data were collected prospectively on all patients admitted for management of AAW during two 3-month periods; before and after the introduction of a symptom triggered regimen. The Clinical institute for Withdrawal Assessment for alcohol scale (CIWA-Ar) was used to assess AAW objectively. The introduction of the STR was overseen by an ALT consisting of a specialist nurse and a consultant at both hospital sites in the trust. Results In the initial period, 102 patients were managed using a fixed-dose regime. Median length of stay (LoS) was 4.0 days (IQR 2–6 days). Median total chlordiazepoxide dose was 260 mg (IQR 120–490 mg). After introduction of STR, 119 patients were included. Median length of stay was 3.0 days (IQR 1.5-5.0 days). Median total chlordiazepoxide dose was 200 mg (IQR 55–450 mg). Age, gender and comorbidities in the before and after groups were comparable. The reduction in length of stay and total chlordiazepoxide dosage following introduction of the STR protocol were statistically significant (p Conclusion Introduction of a STR protocol for management of acute alcohol withdrawal was associated with a reduction in the length of stay and total benzodiazepine dose required. A specialist ALT facilitated the introduction of the STR at two hospital sites in a large teaching hospital trust. The reduction in length of stay alone could contribute to potential cost savings to the trust of around £280 000 per annum. This justifies the presence of an alcohol liaison team in the trust and supports the recommendations of the NICE guidelines. Competing interests None declared.

Published
2012
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2. Symptom triggered pharmacotherapy for acute unplanned alcohol withdrawal can be both clinically and cost-effective in a hospital setting: experience from a specialist hepatology unit.

Author

Glover, L, Collins, P, Gordon, F, Karen, H, Hunt, V, Portal, J, Saleem, S, and McCune, C A

Abstract

Introduction In recent guidance, NICE (2010) recommend a symptom-triggered (STW) pharmacological dosing regimen to treat AAW as both clinically and cost effective. Supporting evidence is from a small number of studies largely undertaken in specialised addiction units and a paucity of published evidence from other settings remains. With this in mind our liver unit formulated and piloted a STW regimen using chlordiazepoxide (CDP). Our aim was to evaluate STW and explore potential cost savings. Methods The STW regimen allowed a maximum daily dose of 240 mg CDP without specialist review. Pharmacotherapy was tailored to the patient's requirements as determined by the severity of their withdrawal signs and symptoms using a designated questionnaire (modified CIWA-AD). Patients were scored hourly or 4 hourly according to protocol score. Data was collected prospectively over a 10-month period (Nov 09 – Aug 10) and case note review undertaken in those previously admitted with AAW (all managed on a fixed dose regimen). Results 135 individuals had STW, each consuming a mean of 28 units of alcohol/day. Most (n= 78, 58%) were admitted with uncomplicated AAW, although over a third had significant liver disease (n=51, 38%). 6 (4%) had no significant liver disease but other serious co-morbidity requiring admission. 41 (30.4%) were previously admitted with AAW. The mean total dose of CDP prescribed during STW was 70.6 mg c.f. 541.6 mg on a fixed dose regimen. A significant number (n= 53, 39%) of STW patients did not require CDP at all, allowing early discharge. Patients on STW required CPD on average for shorter duration (3.11 days vs 7.52 days for fixed dose regimen). In the group admitted with uncomplicated AAW, we estimate within one ward cost savings of at least £220k per annum in bed days alone. Nursing staff welcomed the STW protocol, citing improved patient care and a reduction in violence and aggressive behaviour on the ward. Conclusion Our results support the recommendations made by NICE (2010) that symptom-triggered regimens are associated with lower doses of benzodiazepines, shorter treatment duration and cost-savings, especially in those with uncomplicated AAW. Designated questionnaires (such as CIWR-AD) are a useful adjunct to clinical experience. [ABSTRACT FROM PUBLISHER]

Published
2011
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