INNOVATION FUND Innovation, Integration, & Implementation Emergency and Critical Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Emergency and Critical Care SHOWCASE 2016

A Novel Approach to the Assessment of Alcohol Withdrawal in the Emergency Department

Emergency and Critical Care

ifpoc-guests_0000s_0001_bjug_borgundvaag

Bjug Borgundvaag

bborgundvaag@mtsinai.on.ca

416-586-4800 ext 2144

smcleod@mtsinai.on.ca

416-586-8330

MSH/UHN AMO, Mount Sinai Hospital, University of Toronto

Highlights

We have developed an innovative, web-based, educational curriculum to teach clinicians how to accurately assess and treat alcohol withdrawal. The curriculum includes three e-learning modules, standardized simulated patient scenarios and a summative evaluation in an OSCE setting using a standardized patient. We have developed a pre- and post-assessment tool  to gage knowledge acquisition during the course. These modules have been pilot-tested on 111 ED staff nurses and their feedback is being incorporated into our final design.  Participants have indicated the course has been useful and has positively impacted their clinical practise. Over the next year, we will continue to refine our curriculum and evaluate it’s impact on clinical care in our department. There has been widespread interest in this project provinically, nationally and internationally and we have received many requests for the finished product.

Abstract

Introduction: At its most extreme, alcohol withdrawal syndrome (AWS) results in seizures, delirium tremens and can be fatal. It is best treated using a symptom guided approach, in which treatment is based on regular assessments using a standardized tool (Clinical Institute Withdrawal Assessment-Alcohol revised, or CIWA). There is no training program to teach this competency.

Objective: To develop an innovative, simulation-based, easily disseminated education program to teach clinicians how to accurately identify and treat AWS.

Methods: Results from a needs assessment completed by 122 clinical staff were used to tailor the educational content of three interactive e-learning modules: 1) a 20-min presentation containing core competency material related to the basic pharmacology, identification and management of AWS with a library of real-patient videos depicting the spectrum of AWS tremors; 2) an introduction to the CIWA, focusing on how to asses each of its 10 domains; 3) Five video recorded, standardized patient assessments where learners are asked to assign a CIWA score, diagnosis and disposition plan for each case.

Results: These modules have been pilot-tested on 111 ED staff nurses and their feedback is being incorporated into our final design.  Participants have indicated the course has been useful and has positively impacted their clinical practise. We will continue to refine our curriculum and evaluate it’s impact on clinical care in our department. There has been widespread interest in this project provinically, nationally and internationally and we have received many requests for the finished product.

Conclusion: This electronic resource to teach healthcare workers how to administer and use the CIWA has the potential to improve patient care, shorten ED stays and can be easily and widely disseminated.

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