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Publication Date



2021 prov rn wa, 2021 prov rn poster, washington, spokane




Background: Patients who suffer from alcohol or opioid use disorder face unpleasant and potentially life-threatening complications related to substance withdrawal when hospitalized. Evidence suggests that the use of a standardized tool to rate withdrawal severity and direct treatment, including score-driven medication dosing to alleviate withdrawal, leads to improved clinical outcomes. However, clinical nurses working in the inpatient medical-surgical specialty in a large medical center questioned whether all nurses were effectively using evidence-based practice (EBP) tools to assess and treat alcohol or opiate withdrawal severity.

Purpose/Aims: To understand nursing practice at one hospital regarding use of ministry-specific evidence-based practice tools for rating symptom severity for alcohol and opioid withdrawal.

Methods/Approach: A needs assessment using a cross-sectional survey was conducted to understand nursing practice regarding use of two EBP tools for rating withdrawal symptom severity: the Clinical Institute Withdrawal Assessment for Alcohol (CIWA), and the Clinical Opioid Withdrawal Scale (COWS). Two fictitious withdrawal case studies were developed: one illustrating an inpatient withdrawing from alcohol, and the other depicting withdrawal from opiates. Professional Development Specialists collaborated to enact the scenarios and video recorded each patient case. Nurses working on adult medical-surgical units received an electronic survey link containing the written and recorded patient cases. Nurse participants were instructed to first read and watch each case, then to calculate either a CIWA or COWS score based on the presented cases.

Results: A total of 61 Registered Nurses completed the survey out of a possible 191 eligible nurses. Of these, 97% correctly scored the case illustrating opiate withdrawal using the COWS tool. However, only 35% correctly assigned the CIWA score based on the alcohol withdrawal exemplar. In all, 60% of participants assigned a higher symptom severity than expected using the CIWA tool. The CIWA items with the most inconsistent scores were anxiety, agitation, and visual hallucinations.

Conclusion: Nurses at our ministry responded positively to completing a survey featuring written and videotaped case scenarios to identify gaps in practice using the CIWA and COWS tools. Our innovative needs assessment pointed to a gap in standard practice for using the CIWA but not the COWS tools. Targeted education on enhancing nursing assessment of anxiety, agitation, and visual hallucinations in this population may optimize symptom rating and subsequent protocol-driven treatment.

Implications for Practice: Improper scoring with the CIWA tool could trigger an inappropriate medication dose administered to the patient. A future opportunity to educate nurses in our ministry could lead to an improvement in appropriate alcohol withdrawal symptom rating and treatment.

Clinical Institute

Mental Health




Behavioral Health

Conference / Event Name

2021 Providence RN Conference


Virtual Conference

Inpatient Registered Nursing Use of Evidence-Based Practice Tools to Manage Withdrawal Symptoms among Adults Hospitalized with Acute Alcohol or Opioid Withdrawal:  A Needs Assessment

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Nursing Commons