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Abstract
Introduction Alcohol misuse is a rising problem and alcohol related admissions are common. Alcohol detoxification (DETOX) regimes vary and frequently confuse the prescribers and nurses leading to administration errors, compromising the patient’s care and possibly contributing to early readmissions, by not achieving maximum detoxification. In order to improve that, we have developed and trialled a chlordiazepoxide prescription drug chart in our emergency assessment unit. Following the introduction of the chart there was a significant reduction in prescription and administration errors. The chart is now the standard means of prescribing alcohol detoxification regimes in our hospital.
Methods We reviewed 43 patient’s notes with respect to chlordiazepoxide prescription and identified errors in the prescribed DETOX schedule, timing and missed doses. We then developed a drug chart, which was intended to guide the clinician to assess the severity of alcohol dependence using the severity of alcohol dependency questionnaire (SADQ) and then prescribing the correct chlordiazepoxide schedule, bypassing possible prescription errors. We then reviewed 56 medical notes following the introduction of the drug chart and statistically compared the prescription errors (2 population proportion test). We also compared the median total chlordiazepoxide dose given in milligrams and the duration of regimes in days (t test for 2 independent means) in order to identify a possible impact of those elements to alcohol related early (< 28 days) re-admissions.
Results The chart has led to significant (p < 0.05) reduction of wrong schedule and timing prescriptions, as well as significant (p < 0.05) increase in SADQ score calculation. There was no significant reduction in missed doses. It was also noted that the average length (days) and milligrams of detoxification regimes were inversely proportional to the risk of early re-admission, although these results were not statistically significant, suggesting that the chart might contribute to a reduction in early readmission by ensuring adequate detoxification.
Prescription/administration errors and SADQ score calculation
Conclusion Our experience suggests that DETOX regimes can be cumbersome to prescribe leading to prescription errors, thus compromising patient’s care. The idea of introducing a chlordiazepoxide drug chart was to achieve better care for these patients, by simplifying the prescription process. Our results imply that this was achieved with a suggestion that early readmissions were reduced. The chart is now established as part of alcohol DETOX management at Ipswich Hospital.
References 1 Alcohol Misuse Management Guideline Version 1.0 – 2014, Ipswich Hospital
2 Emergency Medicine Journal, 2014.
3 Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal, NICE Feb. 2010.
4 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, NICE 2011.
Disclosure of Interest None Declared