Psychiatry Newsletter - New Way for Withdrawal
New Way for Withdrawal
Date: April 15, 2013
Is it a dream? I can’t distinguish things. I was sure I was back in a bar. I had no idea I was in a hospital.
Being in a major U.S. medical center while in the midst of alcohol withdrawal, as this actual patient was, isn’t rare. A surprising 17 percent of patients on general medical wards, says one hospital survey that psychiatrist Jeffrey Hsu cites, are caught up in some stage of alcohol withdrawal. That can jump to 50 percent in emergency or intensive care settings, he says—even more in specialized, smaller inpatient units for the very ill with known substance abuse.
What’s also unexpected is that many hospitals lack a standard, updated approach to the problem. Without that, diagnosis can be tricky. Patients’ early-on withdrawal symptoms of insomnia, racing heartbeat, sweating or fever can be attributed to anxiety or infection, even overzealous coffee-drinking.
And treatment is less likely patient-tailored. “At a suspicion of alcoholism, it’s not unusual for patients to routinely get high-dose benzodiazepines followed by a multi-day tapering,” Hsu says. “That can lengthen hospital stays, not to mention hitting patients with higher sedation.”
So a few years back, Hsu helped start a cross-hospital group to explore change. It came first from tactics to raise safety on Johns Hopkins psychiatry wards. “We wanted to identify and manage patients early in alcohol withdrawal, before the complication of seizures set in,” he says.
In 2011, the group designed a flow chart (above) to assess patients’ risk of being in withdrawal. It’s now an online part of inpatient interviews. There’s more: Psychiatric nurse Gigi Rosenblatt headed a move to update nursing staff, and now a new computer course teaches nurses to recognize stages and monitor therapy. And last, says Hsu, there’s every sign that the group’s new treatment protocol—it’s evidence-based and guided by the severity of a patient’s withdrawal—will become the norm.
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