Date of Degree
12-2025
Document Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Program
Nursing
Advisor
Holly DiLeo, PhD, APRN, FNP-BC, Associate Professor, Ila Faye Miller School of Nursing and Health Professions
Abstract
Background: Alcohol withdrawal is a potentially life-threatening condition frequently seen in psychiatric inpatient settings, especially among individuals with co-occurring alcohol use disorder and mental illness. The Clinical Institute Withdrawal Assessment for Alcohol Scale-revised, while widely used, depends on patient self-report, making it less effective for individuals with altered mental status or psychosis.
Purpose: This quality improvement project implemented the Modified Severity Assessment Scale, an objective, observation-based alcohol withdrawal protocol, in an inpatient psychiatric setting to improve safety, treatment accuracy, and care standardization.
Objectives: The project focused on ensuring full staff adoption of the protocol, reducing intensive care unit transfers related to alcohol withdrawal, and aligning benzodiazepine dosing with objectively measured symptom severity.
Methods: The intervention consisted of staff education, integration of the Modified Severity Assessment Scale protocol into the electronic health record, and implementation across all psychiatric units. Data were collected pre- and post-implementation to assess protocol adoption, benzodiazepine administration, hospital length of stay, and intensive care unit transfers. Ethical considerations included obtaining Institutional Review Board approval and protecting patient confidentiality during data collection and analysis. An evidence-based hospital policy was developed to support sustainability and standardization.
Outcomes: Following implementation of the Modified Severity Assessment Scale, the average hospital length of stay decreased from 5.97 days to 3.25 days. Intensive care unit transfers related to alcohol withdrawal declined from three to zero. The average total lorazepam dose per patient decreased from 7.66 milligrams to 1.94 milligrams. All psychiatric providers adopted the protocol, and 100% of staff were trained and compliant.
Implications for Practice: Implementing an objective, symptom-triggered protocol improved standardization of care, medication safety, and overall clinical efficiency. This project demonstrates how evidence-based tools, such as the Modified Severity Assessment Scale, can enhance withdrawal management for complex psychiatric populations, reduce complications, and support the delivery of safe, cost-effective care.
Recommended Citation
Lindsey, Grace R., "Implementation of the Modified Severity Assessment Scale (MSAS) for Alcohol Withdrawal in an Inpatient Psychiatric Unit" (2025). Doctor of Nursing Practice. 127.
https://athenaeum.uiw.edu/uiw_dnp/127
Correct final draft