How UCHealth hospitals lowered death rates for alcohol withdrawal patients in the ICU

A new program to better care for intensive care unit patients experiencing alcohol withdrawal has helped three University of Colorado Health hospitals lower death rates.

Typically, for alcohol withdrawal cases in the ICU, hospitals use heavy sedation, sometimes putting patients on a ventilator. However, this can lead to several potential complications, such as pneumonia, delirium or damage to vocal cords.

The new program, developed by Kristen Boettcher, RN, an ICU nurse at UCHealth Poudre Valley Hospital in Fort Collins, Colo., focuses on alleviating symptoms. Providers should begin treatment by using lorazepam (a sedative) and monitor the patient every 15 minutes for several hours until symptoms are under control. The provider can adjust dosage as the treatment continues, and potentially switch to phenobarbital (another type of sedative).

Ms. Boettcher also switched up the scoring system traditionally used to determine the severity of a patient's withdrawal symptoms. Instead of using the Clinical Institute Withdrawal Assessment for Alcohol, the program incorporates the Alcohol Withdrawal Clinical Assessment scale.

The program was first implemented as a pilot program in spring 2018 in the ICUs at UCHealth Medical Center of the Rockies in Loveland, Colo., and UCHealth Poudre Valley Hospital. It is now a standard of care for alcohol withdrawal patients at the two hospitals. It was then expanded to UCHealth Greeley (Colo.) Hospital. The program is expected to be deployed at other UCHealth hospitals.

The new program has resulted in a drop in rates of intubation and ventilator use at the three hospitals, as well as reductions in death rates. Patients are also transferred put of the ICU 19 hours earlier, on average, since the program was implemented.

Ms. Boettcher recently received the 2019 National Magnet Nurse of the Year Award, in the empirical outcomes category, for her work on this program.

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