Date of Award

Fall 2026

Abstract

Abstract

Background: Alcohol withdrawal syndrome (AWS) can progress to seizures, delirium tremens, and autonomic instability. The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) supports symptom-triggered AWS management, but safe use depends on timely nursing assessment, reassessment, and documentation.

Local Problem: On an adult inpatient psychiatric unit, chart audits identified CIWA-Ar protocol adherence gaps, including missed four-hour assessments and one-hour reassessments after lorazepam.

Methods: This quality improvement project used the Plan-Do-Study-Act model. Three educational reference posters were placed in high-visibility staff areas with QR-linked access to the facility’s AWS protocol and CIWA-Ar scoring guidelines. Outcomes were evaluated using pre- and post-intervention nurse surveys and de-identified chart audit data. Survey measures included six Likert-style items and demographic questions. Chart audits measured completion of four-hour CIWA-Ar assessments and one-hour post-lorazepam reassessments.

Results: Survey responses decreased from 15 pre-intervention to eight post-intervention. Overall satisfaction increased from 4.43 (SD = 0.62) to 4.75 (SD = 0.42), a 7.22% increase. Overall confidence decreased from 4.52 (SD = 0.89) to 4.34 (SD = 1.31), a 4.13% decrease. Only one patient was admitted on CIWA-Ar protocol during implementation, preventing evaluation of intervention-period documentation adherence. Contextual five-month data showed decreased four-hour assessment adherence from 92% to 82% and one-hour reassessment adherence from 88% to 85%.

Conclusions: The poster was associated with improved nurse satisfaction with CIWA-Ar resources but did not improve nurse confidence. Future cycles should include longer implementation, direct engagement measures, and active reinforcement strategies to permit analysis of documentation adherence changes.

Keywords: CIWA-Ar; alcohol withdrawal syndrome; inpatient psychiatry; nursing documentation; quality improvement; PDSA; nursing education; protocol adherence

Document Type

Master's Thesis

First Advisor

Deborah Simonton

Second Advisor

Hazel Adams

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

College or School

CHHS

Department or Program

Direct Entry Master of Science in Nursing - Clinical Nurse Leader

Degree Name

Master of Science

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