Prediction of Alcohol Withdrawal Severity Scale (PAWSS) for patients cared for in an emergency department/Level I...

Patients with alcohol use disorder (AUD) often come to the Emergency Department (ED) for unrelated complaints but can still experience withdrawal. The purpose of this Evidence-Based Practice (EBP) project was to detect the potential for alcohol withdrawal in the ED using the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and then provide necessary treatment to prevent negative patient outcomes (i.e., alcohol withdrawal-related seizures, admissions to the intensive care unit (ICU), and prolonged stays in the ED).

This EBP project was implemented at a Level I Trauma/Academic Medical Center in the Midwest. Nurses were educated on the PAWSS before the project began and then screened patients presenting to the ED using the PAWSS. Patient information collected included: chief complaint (alcohol withdrawal vs other), length of stay (LOS) in ED, total number and type of medications administered for alcohol withdrawal (collected as Phenobarbital and Lorazepam equivalents), disposition (admitted or discharged), alcohol withdrawal seizures, and ICU admissions. These patient outcomes were extracted from the electronic health record and analyzed weekly throughout the course of the project. At the end of the study period, the selected patient information collected during the course of the project were compared to those of pre-project patients in which a revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was documented or those with a chief complaint related to alcohol.

During the project, LOS decreased to an average of 418 min (range: 163-676 min, SD = 106 min) in those with PAWSS score four or greater compared to pre-project numbers. Providers prescribed fewer alcohol withdrawal medications, withdrawal seizures decreased to almost zero, and the number of patients requiring ICU admission decreased from 10 to 7.

Implementation of PAWSS resulted in decreased ED LOS, decreased ICU admissions, and decreased use of medications for the treatment of alcohol withdrawal. These promising results suggest PAWSS is a valuable screening tool for ED patients with the potential for experiencing alcohol withdrawal.