Title : Implementation of withdrawal protocols upon ICU admission to enhance patient outcomes
Abstract:
In the Intensive Care Unit, the focus is to stabilize the patient and correct the acute problems. A history of substance abuse is often overlooked if the patient is intubated, sedated, and/or not exhibiting acute signs of withdrawal. This poster presentation exhibits the results of literature reviews on substance abuse amongst critical care patients, and whether the implementation of a withdrawal protocol upon admission will decrease time on the ventilator, ultimately decreasing length of stay. Overlooking a history of polysubstance abuse can have negative effects on patient outcomes such as agitation, combativeness, hallucinations, delirium/tremens, seizures, hypertension, tachycardia, tachypnea resulting in intubation to protect the airway. To perform Spontaneous Breathing Trials the patient must have a mental status and be able to follow commands which cannot occur during the withdrawal phase requiring increased sedation, restraints, or 1 to 1 monitoring. This creates a stressful patient care environment that is not conducive to healing. This literature review identified a variety of study designs with methods that significantly improved patient outcomes by utilizing benzodiazepines according to a comprehensive detoxification protocol to prevent Alcohol and Opioid Withdrawal. Adjunctive therapies are also addressed for Cannabis and Tobacco Withdrawal. Databases used were PubMed, National Institute of Health, Journal of Emergency Medicine, and others. Results from search terms: Withdrawal AND ICU, Withdrawal Protocols AND length of stay, along with ICU AND Withdrawal, provided studies with positive patient outcomes when withdrawal protocol is initiated upon ICU admission in the form of decreased number in intubations, early extubations, and decreased length of stay. Based on the findings of the literature review, the use of nurse driven protocols such as the Yale Alcohol Withdrawal Protocol and or the Clinical Institute Withdrawal Assessment provided quantifiable evidence of the patient’s struggle with addiction which in turn has a direct effect on the plan of care. Working collaboratively with the medical team, discussing our concerns with findings backed by research, hospital guidelines, and protocols will improve care and decrease mortality rates for this vulnerable population.
Audience Take Away:
- Assess and identify patients with polysubstance abuse disorder in the Intensive Care Unit
- Implement appropriate withdrawal protocol for patients in the Intensive Care Unit
- Improve patient outcomes and decrease cost within the Intensive Care Unit by preventing hospital acquired infections and decreasing length of stay.
- Provide education and awareness on withdrawal protocols to their organizations
