{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T20:17:46Z","timestamp":1775247466054,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,20]],"date-time":"2018-11-20T00:00:00Z","timestamp":1542672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Mount Sinai Hospital-University Health Network Academic Medicine Network (MSH-UHN AMO) Innovation Fund"},{"name":"SIMone\/IDEAS\/CPSI Simulation for Safety & Quality Improvement Program"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["AEM Education and Training"],"published-print":{"date-parts":[[2019,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Ideal management of alcohol withdrawal syndrome (\n AWS<\/jats:styled-content>\n ) incorporates a symptom\u2010driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol\u2013Revised [\n CIWA<\/jats:styled-content>\n \u2010Ar]) and treated according to severity. Accurate administration of the\n CIWA<\/jats:styled-content>\n \u2010Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat\n AWS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a three\u2010phase education program consisting of a series of e\u2010learning modules containing core competency material, an in\u2010person seminar to orient learners to high\u2010fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the\n AWS<\/jats:styled-content>\n curriculum, we recorded how often the\n CIWA<\/jats:styled-content>\n \u2010Ar was appropriately applied in the emergency department (\n ED<\/jats:styled-content>\n ) before and after training. A\n CIWA<\/jats:styled-content>\n \u2010Ar protocol breach was defined as inappropriate administration of benzodiazepines (\n CIWA<\/jats:styled-content>\n \u2010Ar\u00a0<\u00a010) and failure to administer benzodiazepines when required (\n CIWA<\/jats:styled-content>\n \u2010Ar \u2265 10).\n ED<\/jats:styled-content>\n length of stay, amount of benzodiazepines administered in the\n ED<\/jats:styled-content>\n , discharge prescriptions, and unit doses (take\u2010away bottle of four tablets) of benzodiazepine given were recorded.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy\u2010four\n ED<\/jats:styled-content>\n nurses completed the curriculum over an 8\u2010week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%)\n CIWA<\/jats:styled-content>\n \u2010Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (\u220613.8%, 95% confidence interval [\n CI<\/jats:styled-content>\n ]\u00a0= 9.3%\u201318.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the\n ED<\/jats:styled-content>\n (40\u00a0mg vs. 30\u00a0mg, \u220610\u00a0mg, 95%\n CI<\/jats:styled-content>\n \u00a0= 0\u201320\u00a0mg) and no change was detected in\n ED<\/jats:styled-content>\n length of stay and benzodiazepines prescribed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Completion of this curriculum resulted in better compliance with the\n CIWA<\/jats:styled-content>\n \u2010Ar protocol by those who administer the\n CIWA<\/jats:styled-content>\n \u2010Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.\n <\/jats:p>\n 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