Microsoft word - alcohol withdraw physician standing order.doc

Alcohol Withdrawal Syndrome
PHYSICIAN Pre-Printed Orders

Check box to activate orders below if applicable.
Cross off non-applicable orders with a single line.
ALLERGIES: ‰None Known ‰Yes

‰ Psychiatric Consult
‰ “Suicide Risk Assessment Tool” post withdrawal (required for all patients once withdrawal completed)
Implement Withdrawal Syndrome Precautions. Score patient using Richmond Agitation Sedation Scale. Desired
RASS score is 0 to -1
Thiamine 100 mg po daily x 3 days
Folic Acid 1 mg po daily x 3 days
Multivitamin 1 tablet po daily
If patient unable to take PO:
Thiamine 100 mg & Folic Acid 1 mg IV in 100 ml Normal Saline over 1 hour x 3 days
1 liter D5NS with 20meq KCL at __________/hour. (Start after first piggyback of Thiamine and Folic Acid finishes or patient has taken PO vitamins. Obtain a serum magnesium and potassium on admit and daily while on withdrawal protocol and treat per Potassium Magnesium Replacement Protocol.
Select either 5a or 5b and check appropriate boxes:

Low Risk for Alcohol Withdrawal Delirium: *1
(This regimen preferred for patients with COPD or respiratory illness) ‰Lorazepam 1 mg PO or IV every 1 hour PRN early withdrawal symptoms High Risk for Alcohol Withdrawal Delirium: *2
‰Lorazepam 2 mg PO or IV every 4 hours x 12 doses then Lorazepam 1 mg PO or IV every 6 hours x 6 doses then discontinue order and give ‰Lorazepam 1 mg PO or IV every 1 hour PRN early withdrawal symptoms. For Acute Alcohol Withdrawal Delirium Treatment Regimen: *3 (Notify the attending physician and the
hospitalist of acute alcohol withdrawal and inquire regarding ICU transfer.)
6. Lorazepam 2 mg IV every 15 minutes PRN. (If patient needs 8mg in 1 hour OR if severe agitation continues
with Richmond score of +3 or greater contact physician for medication order that will treat delirium and transfer the patient to ICU.) ‰ Haldol _____mg IV is for sedation every 4 hours PRN (ICU only) and check QTc interval prior to administration
of drug, notify physician and hold Haldol if QTc 500 msec or greater.
8. Recheck QTc 2 hours after first dose of Haldol and every 8 hours. Notify physician if QTc is greater than 500 msec or there is a change of greater than 80 msec and discontinue Haldol. G:\FORMS\Forms for EMR\BAR CODED Forms\ORDER\Alcohol Withdraw Physician Standing Order.doc Last printed 2/5/2013 3:38:00 PM POLICY: Share (G):\ Dept P&Ps \ Nursing \ Alcohol Withdrawal Syndrome-Screen Assess Treat.doc (Attachment B) Note: This page does not require a patient label Alcohol Withdrawal Syndrome
PHYSICIAN Pre-Printed Orders

General Information
Acute Alcohol Withdrawal Syndrome occurs when early alcohol withdrawal symptoms are not promptly recognized and treated. Treatment with benzodiazepines should reduce or eliminate withdrawal symptoms.
Early alcohol withdrawal symptoms to monitor all patients for include:
GI Complaints: Nausea, vomiting, anorexia Peripheral Nervous System Hyperactivity: Tremor, tachycardia, tachypnea, hypertension, fever, and Central Nervous System Complaints: anxiety, insomnia, restlessness, light/sound sensitivity, headache
*1Low Risk:
No prior history of alcohol withdrawal symptoms (“shakes”) or history of acute alcohol withdrawal, patient consumes minimal (less than or equal to 2 drinks per day) alcohol, patient is not exhibiting any signs/symptoms of early alcohol withdrawal.
*2High Risk:
Prior history of acute alcohol withdrawal syndrome, history of withdrawal seizures, daily consumption of large quantities (more than 2 drinks per day) of alcohol, patient exhibits signs/symptoms of early alcohol withdrawal.
*3Acute alcohol withdrawal delirium requiring physician notification:
Early alcohol symptoms (see above) and, dry heaves, drenching sweats, agitation, panic, seizures, visual,
tactile, and/or auditory hallucinations confusion, disorientation, agitation and/or marked tremor.

All patients will be scored using Richmond Sedation Scale.
The goal of sedation will be a 0 to –1 on the scale below:
Richmond Agitation Sedation Scale
Overtly combative, violent, immediate danger to staff
Very agitated
Pulls or removes tube(s) or catheter(s); aggressive
Frequent non-purposeful movement, fights ventilator
Anxious but movements not aggressive or vigorous
Alert and calm
Not fully alert, but has sustained awakening (Eye-
-1 Drowsy
opening/contact) to voice ( 10 seconds)
sedation Briefly awakens with eye contact to voice (< 10seconds)
Moderate sedation Movement or eye-opening to voice (but no eye contact)
No response to voice, but movement or eye opening to physical
sedation stimulation
No response to voice or physical stimulation
G:\FORMS\Forms for EMR\BAR CODED Forms\ORDER\Alcohol Withdraw Physician Standing Order.docLast printed 2/5/2013 3:38:00 PM Rev/Appd 5/11



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