An audit of symptom triggered chlordiazepoxide treatment

Second, as this was a QA project, the findings are limited by a convenience
sample from two different units: ICU and psychiatry. The two patient populations
are clearly different in regard to non-AWS medical and psychiatric status, and this
may impact the outcome differences seen. A counterargument holds that this
population difference may not be as pronounced as the unit names suggest
because the pathophysiology of AWS is consistent across settings. The data
showing consistently similar administration rates of each scale in two separate
settings allow that the latter may be the more likely case.
In light of these limitations, a randomized, double-blind clinical trial applying
the two scales to the same patient group sample will be needed to determine
whether the source of divergence lies in the accuracy of the scales themselves. The
current QA design provided in response to clinical necessity should be replaced by
a controlled comparison of the two scale-driven protocols. Clinical trials outside
the VA health care system will also be required to accrue sufficient samples of
female AWS patients to allow for analysis of possible gender differences.
Our work to date suggests, but does not demonstrate, that SEWS-driven
treatment (1) shortens AWS withdrawal treatment course, (2) better accounts
for the early symptoms of AWS than does the CIWA-Ar, and (3) drives benzodiazepine
dosing for the treatment of AWS more effectively. The QA experience
strongly suggests one further characteristic of SEWS-driven AWS treatment not
directly addressed in this QA design: its ease of use. Follow up in our institution
notes that the ICU nurses complimented the SEWS on systematizing AWS
treatment where no standard approach existed in that setting before. This has
led to its implementation in all of the general medical and surgical units. Further,
our local community’s public hospital (Denver Health Medical Center), that has a
high AWS volume, began using the SEWS in their clinical services. They have
independently noted the SEWS’ ease of use in that setting (Sankoff, Taub, &
Mintzer, 2013). Exploration of the ease-of-use factor requires additional nursing