ABSTRACTAlcohol withdrawal and liver disease require careful medical and self-management to decrease mortality rate. Alcoholism has been proven to increase the risk of liver disease with its associated complications (2). The purpose of this project is to provide new hire nurses, working in Intermediate Care, the necessary information and tools to manage patients experiencing alcohol withdrawal and the potential complications. New hire nurses often lack knowledge of the medical management required for alcohol withdrawal syndrome. The benefits of providing the necessary information and tools for nursing staff include keeping patients and nurses safe. Utilization of the chronic care model(3) is outlined in the project design and implementation. Evaluation of the project involves assessing the knowledge and skills of new nurses using case studies.

PICO QUESTIONFor new RNs working on the Intermediate Care Unit, how does orientation and review of interventions for patients experiencing alcohol withdrawal compare to no orientation and review of interventions affect a safe environment for both RNs and patients?

LITERATURE REVIEWResearch revealed that no consistent or standardized model of care for patients experiencing alcohol withdrawal is being utilized. In addition, the following laboratory tests have been proven indicators of alcoholic liver disease and are associated with long-term use of alcohol consumption (4). • Alanine transaminase (ALT)• Gamma-glutamyl transferase (GGT)• Platelet count• Bilirubin

ALCOHOLIC LIVER DISEASE:Treatment for Alcohol Withdrawal & Management

Angie L. Bacon, BSN, RN, MSN Student

Plan and DevelopmentDeliverable products were developed and recommended and included the following:•Pre-Assessment Survey, which included case studies. •PowerPoint presentation highlighting the treatment for alcohol withdrawal. •Post-Assessment Survey, which included case studies.•Collaboration with IMC Educator and Management Team to achieve endorsement.

EvaluationDevelopment of pre- and post-assessment survey to be administered to new hire nurses on IMC to provide information about the following:•Treatment of patients experiencing alcohol withdrawal. •CIWA protocol for the patient experiencing alcohol withdrawal.•Evaluation of the effectiveness of provided medical management education. •Alter alcohol withdrawal education to promote effectiveness as needed (post-survey results).

THEORETICAL FRAMEWORKChronic Care Model (3) focuses on providing patient-centered care utilizing six critical elements of care as follows: • Self-management & support• Healthcare delivery system• Systematic decision making and support• Clinical information technology• Links to community resources• Healthcare system organization

CONCLUSIONSTreating patients who have been diagnosed with alcoholic hepatitis or alcoholic liver disease remains complex for the healthcare team. Training new nurses how to safely manage and treat a patient with alcohol withdrawal syndrome using the CIWA protocol is the first step in developing a standardized model of evidence-based care to improve patient outcomes and decrease complications. Testing of liver function for patients admitted for alcohol withdrawal should be added to the protocol and should include a thorough workup of the patients, such as the following:• Physical assessment and health history• Assessing biomarkers M30 and M65• Liver enzymes, including ALT, AST, and GGT

REFERENCES1. Agarwal, S., Fulgoni, V. L, & Lieberman, H. R. (2016). Assessing alcohol intake &

its dose-dependent effects on liver enzymes by 24-h recall and questionnaire using NHANES 2001-2010 data. Nutrition Journal, 15(1), 62. http://doi:10.1186/s12937-016-0180-y.

2. Centers for Disease Control and Prevention. (2016). Chronic liver disease and cirrhosis. Retrieved from https://www.cdc.gov/nchs/fastats/liver-disease.htm.

3. Kadu, M. K., & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care model in primary care: A systematic review. BMC Family Practice, 16(1), 12-12. doi:10.1186/s12875-014-0219-0.

4. Lawlor, D. A., Benn, M., Zuccolo, L., De Silva, N. M. G., Tybjaerg-Hansen, A., Smith, G. D., & Nordestgaard, B. G. (2014). ADH1B and ADH1C genotype, alcohol consumption and biomarkers of liver function: Findings from a Mendelian randomization study in 58,313 European origin Danes. PLoS ONE, 9(12), 1–14. http://doi.org/10.1371/journal.pone.0114294.

5. Niemelä, O., Niemelä, M., Bloigu, R., Aalto, M., & Laatikainen, T. (2017). Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers? PLoS One, 12(12), e0188574. http:/doi:10.1371/journal.pone.0188574.

6. Sulava, E., Bergin, S., Long, B., & Koyfman, A. (2017). Elevated liver enzymes: Emergency department-focused management. The Journal of Emergency Medicine, 52(5), 654-667. http://doi:10.1016/j.jermermed.2016.10.016.

PROJECT METHODOLOGYA need for education related to the treatment of patients experiencing alcohol withdrawal was identified after witnessing multiple newly hired nurses in a regional area fail to recognize CIWA protocol and fail to follow CIWA management guidelines. Initial evidence exploration was focused on patients experiencing alcohol withdrawal and associated liver function tests.

A thorough review of literature yielded sufficient evidence to support the recommendation to implement the chronic care model(3) to improve patient care, impact clinical outcomes positively, reduce the resources used in a clinical setting, and decrease costs associated with treating chronic conditions such as alcoholism. The literature review also revealed that high levels of the liver enzymes, such as ALT, AST, and GGT, are associated with long-term alcohol consumption, which leads to alcoholic hepatitis and alcoholic liver disease(1, 5). Therefore, the higher the level of ALT, AST, and GGT, then the greater risk of developing alcoholic liver disease resulting from untreated alcohol-related conditions(6).

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