Standardized Procedure for Alcohol Disorder

1. Purpose

1. The goal of this standardized protocol is to delineate the role that the Nurse Practitioner plays in maintaining their scope of practice in a particular procedure. In order for all of the members of the health care team, including the providers, to have an understanding of the NP’s scope of practice, the nurse practitioner (NP) must satisfy the legal requirements of the provisions provided to nurse practitioners by the California Board of Nursing. These standardized protocols provide medical professionals and patients the confidence they need that the nurse practitioner (NP) is delivering the highest possible level of quality and efficiency in the medical treatment that they are receiving.
2. The 11 recommendations that were developed jointly by the California Board of Registered Nursing and the Medical Board of California shall be followed by this standardized procedure.
3. The Medical Practice Act grants doctors the authority to diagnose mental and physical disorders, to use medications in or upon human beings, to sever or penetrate the tissue of human beings, and employ other techniques in the treatment of illnesses, injuries, deformities, or other physical or mental conditions. In addition, the act allows physicians to use medications in or upon human beings. A standardized procedure is required for a registered nurse or a nurse practitioner to conduct any of these duties, and this requirement serves as a general guide. Standardized Procedure for Alcohol Disorder Essay Paper

1. Development and Review

1. These standardized procedures have been developed by physicians, nurse practitioners, nurses, and administrative representatives participating in the care of and as a part of the care team of patients in accordance with California Law.
2. These standardized procedures will be reviewed and revised as needed and determined by the need for change in the clinical setting or as regulatory guidelines warrant a revision or every two years.

1. Upon hire, each nurse practitioner will approve, sign, and abide by the practice guidelines mandated within and will update the signature as needed with changes or annual review. Authorization to perform these procedures will be revoked if the nurse practitioner does not provide a valid signature upon hire or updated guidelines.

• Scope and Setting

1. The Nurse Practitioner is authorized to perform this standardized procedure within the setting provided by the clinic as well as through tele-medicine, as determined by the provider’s specialty area.
2. The practitioner will stay within their scope of practice consistent with their training, experience, and credentials. The NP will perform functions of treatment that include assessment, evaluation, diagnosing, planning care, ordering needed diagnostic procedures, and making referrals to specialty areas as needed to provide optimal care to the patient.
3. Education and Training/Qualifications

1. The Nurse Practitioner performing this standardized procedure will:
2. Maintain a valid license as a Registered Nurs
3. Maintain board certification as a Nurse Practitioner

• Basic Life Support (BLS) certification

1. Current Board certification from the American Nurses Credentialing Center
2. NP furnishing number provided by California board of Nursing
3. DEA registration number to provide prescriptions
4. Nurse Practitioner must complete annual competencies on hire and annually by proving competence to the physician and appropriate management staff. Competencies will be updated and added-to as needed and determined by appropriate staff.

1. Supervision and Evaluation

1. The supervising physician for the nurse practitioner will be the medical director of the clinic, with the medical director evaluating a percentage weekly of the nurse practitioner’s cases to maintain the quality of service and proper scope of the NP.
2. The NP is approved to implement the standardized procedures without the direct supervision of the collaborating physician unless it is specifically stated otherwise within the standardized procedure. The physician and NP will maintain the collaborative agreement and will participate in decisions jointly where needed.

1. Per California law, a physician will only be able to supervise four NPs at most so that he/she may be available when needed by collaborating NPs.
2. Consultations
3. Collaborating/supervising physician will be available, by phone or in person, to consult with the NP at any time while the NP is performing his/her duties, for any reason the NP may feel it necessary to do so.
4.  Any consultation with the supervising physician will be recorded appropriately in the patient record. The recommendations made by the physician will also be recorded.  Standardized Procedure for Alcohol Disorder Essay Paper

• Patient Records

1. Any medical record of the patient will be held in confidentiality and secure in an electronic medical record. These records will be complete and kept up-to-date by the NP for each visit of the patient according to existing clinic and medical staff policies.
2. All patient records will be maintained and kept private in accordance with HIPAA guidelines.
   

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Health Care Management Protocol

Protocol:

Visit for Alcohol withdrawal syndrome

1. Rationale

This standardized procedure will assist the nurse practitioner in an outpatient clinic setting to accurately diagnose a patient with alcohol withdrawal syndrome and to be able to treat this disorder efficiently and effectively.

1. Definition

Alcohol withdrawal syndrome is a condition that may manifest in a person when they have been heavy drinkers for a lengthy amount of time and suddenly cut down or quit drinking altogether. Within hours after the last drink, a person may begin to experience mild symptoms, which, if not addressed, may evolve into more serious and even life-threatening symptoms. The onset of symptoms might range anywhere from two hours to four days following the last drink (Jesse et al., 2017). Headaches, nausea, tremors, anxiety, hallucinations, and seizures are some of the possible symptoms.

Epidemiology

1. There are roughly 8 million people who are diagnosed with alcohol dependence each year in the United States, and nearly half of those people have alcohol withdrawal symptoms when their alcohol usage is cut down or stopped altogether (Pace, 2020).
2. Withdrawal from alcohol is uncommon in people less than 30 years old, and the severity of the symptoms rises with increasing age.
3. Seizures and delirium tremens are examples of severe alcohol withdrawal symptoms that may be seen in 5% of people going through alcohol withdrawal (Grover & Ghosh, 2018).
4. Patients suffering from alcohol withdrawal and delirium tremens (DT) have a mortality rate of 5% due to a variety of problems. In people from middle-class backgrounds who are struggling with alcohol use disorder, the incidence of alcohol withdrawal is roughly fifty percent (Pace, 2020).
5. It is estimated that around 80 percent of those with alcohol use disorder who are hospitalized or living on the streets are also experiencing alcohol withdrawal (Pace, 2020).
6. Roughly 20 percent of males and 10 percent of women have an alcohol use problem. In about half of those people, alcohol withdrawal symptoms will be experienced when the amount of alcohol they consume decreases (Pace, 2020).

III. History

1. Nature and duration of the patient’s alcohol withdrawal symptoms.
2. Progression of the symptoms.
3. Duration of alcohol dependence.
4. Volume of alcohol typically ingested
5. Time of the last drink
6. History of prior delirium tremens
7. History of thrombocytopenia or hypokalemia
8. Underlying disease processes like infection, dehydration, traumatic injury, cardiac issues, gastrointestinal bleeding, and electrolyte abnormalities. (Newman et al., 2021).
9. Mental status Exam and Medical History
10. It is important to conduct the mental status exam in order to conduct quantitative and qualitative evaluations of a variety of mental functions and behaviors at a certain moment in time. The mental status exam gives essential information that may be used for diagnosis, as well as for assessing the course of the condition and how well it responds to therapy (Voss & Das, 2021).
11. When it comes to meeting the requirements of persons with mental illness in terms of their physical health, a thorough medical history is a crucial beginning point.
12. Diagnostic tests
13. Electrolyte panel
14. BUN and serum creatinine
15. Ethanol concentration
16. LFTs
17. Differential Diagnosis
18. Alcohol intoxication
19. Psychomotor deficit
20. Refractory delirium tremens

VII. Management Guidelines

1. Achieve detoxification
2. Provide general supportive care
3. Choose effective medication for detoxification
4. Prevent the progression to serious medical complications
5. Ensure symptom monitoring

(Airagnes et al., 2017)

VIII. Treatment

When treating alcohol withdrawal syndrome, the goals of treatment are to control the signs and symptoms of the condition, avoid the development to more significant medical consequences, and connect individuals to treatment for sustaining long-term recovery. Those who are experiencing very minor symptoms may simply need supportive treatment, whereas patients who are experiencing moderate to severe symptoms may merit the involvement of drug therapies: The following are medications commonly prescribed for alcohol withdrawal syndrome. Standardized Procedure for Alcohol Disorder Essay Paper

1. Lorazepam- This is a benzodiazepine medication that is normally used to address psychomotor agitation associated with alcohol withdrawal. A patient who is extremely agitated may benefit from treatment with lorazepam, which has been shown to be helpful in clinical studies (Amore et al., 2021). It provides a long duration of seizure control because of its slow redistribution.
2. Phenobarbital- This is a long-acting barbiturate that has been used effectively to treat alcohol withdrawal and refractory delirium tremens. It has been shown to have anticonvulsant efficacy, is not prohibitively costly, and may be taken orally, injected intramuscularly, or administered intravenously (Fujimoto et al., 2017).

1. Approval of Standardized Procedure on alcohol withdrawal.

This standardized procedure was developed for a particular clinic for the treatment of patients who were going through alcohol withdrawal, and it was approved by the care team, which was comprised of physicians, nurse practitioners, registered nurses, and administrative staff in order to provide high-quality care. This standardized procedure will be evaluated every five years in order to ensure that it is kept up to date as necessary in order to provide patients with the greatest possible level of medical treatment.

Revision date                                          Review date                                 

1. Standardized procedure was approved by the following members of the care team.

Supervising physician

                                                Date                                 

Administrative Personnel

                                                Date                                 

Nurse Practitioner

                                                 Date                                 

Director of Nursing Practice

                                                Date                                 

1. Nurse Practitioners authorized to operate under this standardized procedure will be maintained on file in the administrative office or clinic office in which the nurse practitioner’s practice as well as human resources.

References

Airagnes, G., Ducoutumany, G., Laffy-Beaufils, B., Le Faou, A., & Limosin, F. (2019). Alcohol withdrawal syndrome management: Is there anything new? La Revue de Médecine Interne, 40(6), 373-379. https://doi.org/10.1016/j.revmed.2019.02.001

Amore, M., D’Andrea, M., & Fagiolini, A. (2021). Treatment of agitation with Lorazepam in clinical practice: A systematic review. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.628965

Fujimoto, J., Lou, J. J., & Pessegueiro, A. M. (2017). Use of Phenobarbital in delirium tremens. Journal of Investigative Medicine High Impact Case Reports, 5(4), 232470961774216. https://doi.org/10.1177/2324709617742166

Grover, S., & Ghosh, A. (2018). Delirium tremens: Assessment and management. Journal of Clinical and Experimental Hepatology, 8(4), 460-470. https://doi.org/10.1016/j.jceh.2018.04.012

Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M., & Ludolph, A. (2017). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4-16. https://doi.org/10.1111/ane.12671

Newman, R. K., Gallagher, M. A. S., & Gomez, A. E. (2021). Alcohol withdrawal. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441882/

Pace, C. (2020). Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis. UptoDate, 28, 2020. https://www.medilib.ir/uptodate/show/108527

Voss, R., & Das, J. M. (2021). Mental status examination. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/24998

Standardized Procedure for Alcohol Disorder Essay Paper