Compliance with Glasgow Modified Alcohol Withdrawal Scale Guidelines within Emergency Medicine Utilising Electronic Prescribing Protocols
Authors: Dobie S , Hayburn H 
Published: November 2023

Abstract

Introduction
Glasgow Modified Alcohol Withdrawal Scale (GMAWS) allows evidence-based management of patients at risk of alcohol withdrawals within the hospital setting. Adherence to this guideline mitigates risk of patients developing Wernicke-Korsakoff syndrome, a neurological disorder resulting from a thiamine deficiency induced by chronic alcohol consumption1. As Scotland has particularly high rates of alcohol misuse, utilisation of this guideline avoids development of this serious complication with a large at-risk population. However, non-compliance and incorrect prescribing has been prevalent as this can be difficult and time-consuming to manually prescribe leading to errors. This can be avoided by utilising the novel electronic prescribing protocol on Hospital Electronic Prescribing and Medicine Administration (HEPMA) programme.

Aim
The aim of this quality improvement project was to increase compliance with the GMAWS guideline and ensure correct prescribing within Emergency Medicine.

Methods
Data collection was supported by the HEPMA team, with daily reports of all identified patients to allow evaluation of GMAWS prescribing as per protocols. Identified patients were confirmed to be on GMAWS and not prescribed thiamine/benzodiazepines for another indication with presence of GMAWS paper chart. Data was initially collected over a two-week period to establish a baseline, with further two-week periods of data collection after interventions. Intervention 1 was distribution of a hospital wide memo regarding GMAWS protocol. Intervention 2 was buzzword teaching on GMAWS with small groups of prescribers. This study did not require ethics approval due to it being a service evaluation / improvement project.

Results
The data collection following interventions demonstrated improved compliance with HEPMA protocols, evidenced by an increase from 33.3% at baseline to 82.1% compliance. The intervention of buzzword teaching was most impactful with 82.1% compliance recorded following this. An overall increase of 55.6% in the total prescribing of GMAWS signifies an increased awareness of the guidelines and increased confidence with prescribing.

Discussion/Conclusion
As novel electronic prescribing continues to evolve, pharmacy is a main contributor for advocating optimised prescribing and supporting best practice. Significant learning points included that many patients were on unnecessarily prolonged courses of parental thiamine, which has significant cost and nursing time implications. This is supported by the fact that oral thiamine costs 0.5% of the total cost of giving parental thiamine daily and reduced risks from unnecessary prolonged cannulation. We were able to incorporate this learning into the buzzword teaching to prompt review of parental thiamine prescribed without a clear duration. This project has prompted a review of our health board’s GMAWS guideline to streamline and update guidance in line with updated NICE guidelines. Feedback from the buzzword teaching sessions has been incorporated to improve readability and aid use, via the rationalisation of the GMAWS paperwork. The corresponding HEPMA protocols will then be updated to reflect these changes. Furthermore, this work has influenced other specialities to create and teach the use of HEPMA protocols to optimise treatment.

References
1. Moghekar A. Wernicke’s encephalopathy [Internet]. Wernicke’s encephalopathy - Symptoms, diagnosis and treatment | BMJ Best Practice. BMJ Best Practice; 2020 [cited 2023Mar3]. Available from: https://bestpractice.bmj.com/topics/en-gb/405