Quality standard

Quality statement 4: Acute alcohol withdrawal

Quality statement 4: Acute alcohol withdrawal

Quality statement

Adults in acute alcohol withdrawal in hospital are assessed and monitored following locally specified protocols. [new 2023]

Rationale

Adults in acute alcohol withdrawal in hospital may need care from 1 or more services and further assessment to determine what care is needed. Locally specified protocols will provide guidance for next steps, treatment, and the appropriate setting for care. They also need ongoing monitoring to ensure that their treatment is meeting their needs. This will help ensure that they receive appropriate treatment and do not develop critical care needs and complications such as alcohol withdrawal seizures, Wernicke's encephalopathy, or delirium tremens.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local processes and written protocols for the assessment and monitoring of adults in acute alcohol withdrawal in hospital.

Data source: Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from care pathways.

Process

a) Proportion of adults in acute alcohol withdrawal in hospital assessed following locally specified protocols.

Numerator – the number in the denominator who are assessed following locally specified protocols.

Denominator – the number of adults in acute alcohol withdrawal in hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient and service user records.

b) Proportion of adults in acute alcohol withdrawal in hospital monitored following locally specified protocols.

Numerator – the number in the denominator who are monitored following locally specified protocols.

Denominator – the number of adults in acute alcohol withdrawal in hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient and service user records.

Outcome

Rates of completed withdrawal from alcohol in hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient and service user records.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that systems are in place for adults in hospital in acute alcohol withdrawal to be assessed and monitored following local protocols by healthcare professionals skilled in assessing and monitoring withdrawal symptoms and signs.

Healthcare professionals (such as doctors and nurses) assess and monitor adults in hospital who are in acute alcohol withdrawal following local protocols.

Commissioners ensure that they commission services that have local protocols for assessment and monitoring of adults in acute alcohol withdrawal in hospital.

Adults in hospital who are in acute alcohol withdrawal have their needs assessed and their condition monitored by skilled healthcare professionals, who follow local processes to ensure the treatment they receive is right for them.

Definitions of terms used in this quality statement

Acute alcohol withdrawal

The physical and psychological symptoms that people can experience when they suddenly reduce the amount of alcohol they drink if they have previously been drinking excessively for prolonged periods of time. [NICE's guideline on alcohol-use disorders: diagnosis and management of physical complications, terms used in this guideline]

Locally specified protocols

In the context of this quality statement, this refers to evidence-based protocols for assessment, as soon as possible after presentation of alcohol dependence, and monitoring of people in hospital with acute alcohol withdrawal. Assessment and monitoring should be carried out by skilled health and social care practitioners to support treatment and care for acute alcohol withdrawal, based on the person's needs. Such treatment and care may include:

  • offering pharmacotherapy to treat symptoms of acute alcohol withdrawal

  • a symptom-triggered regimen for drug treatment

  • advice from an experienced healthcare professional for people with decompensated liver disease 

  • offering information on how to contact local alcohol support services

  • offering prophylactic oral thiamine.

Assessment should be made using clinical judgement and possibly a tool that gives a validated score such as the Clinical Institute Withdrawal Assessment – Alcohol, revised [CIWA–Ar] scale.

Protocols are agreed and implemented in local health and social care systems, and should specify what assessment and monitoring should include, who should conduct it, and any tools that may be used. [NICE's guideline on alcohol-use disorders: diagnosis and management of physical complications, recommendations 1.1.2.2, 1.1.2.3, 1.1.3.1 to 1.1.3.4, 1.2.1.2, and expert opinion]

Equality and diversity considerations

The presence of stigma in healthcare settings towards people with an alcohol-use disorder in general should be considered when conducting assessment and monitoring, as well as the effect of cultural factors on openly discussing alcohol-use disorders for people from some faith groups.

Some people in acute alcohol withdrawal, such as those who may lack capacity, those with learning disabilities and those experiencing homelessness may benefit from the involvement of an advocate when having their needs assessed (see NICE's guideline on advocacy services for adults with health and social care needs).