CIWA-Ar Alcohol Withdrawal Assessment Log

Inspection template for scoring the 10-item CIWA-Ar alcohol withdrawal scale, documenting repeat assessments at protocol intervals, and recording medication response and escalation actions.

Assessment Context and Timing

• Assessment date and time recorded
• Assessment type identified
• Protocol interval met
  Confirm the reassessment was completed at the ordered CIWA-Ar protocol interval or sooner if clinically indicated.
• Patient able to participate in assessment
  Patient is awake enough and able to answer questions or cooperate with observation-based scoring.
• Last alcohol use documented
• Concurrent sedating medication or confounding factor noted
  Document factors that may affect interpretation of CIWA-Ar findings, such as recent benzodiazepine administration, other sedatives, delirium, or communication barriers.

CIWA-Ar Item Scoring

• Nausea and vomiting score
• Tremor score
• Paroxysmal sweats score
• Anxiety score
• Agitation score
• Tactile disturbances score
• Auditory disturbances score
• Visual disturbances score
• Headache and fullness in head score
• Orientation and clouding of sensorium score

Total Score and Clinical Interpretation

• Total CIWA-Ar score
• Severity category documented
• Protocol action based on score documented
  Document whether the score triggered continued observation, medication administration, provider notification, or higher level of care.
• Provider notified for concerning findings
  Use when score, symptoms, or mental status indicate need for escalation per protocol.

Medication Response and Escalation

• Medication administered per protocol
• Medication name and dose
• Clinical response documented
  Record whether symptoms improved, remained unchanged, or worsened after intervention.
• Repeat CIWA-Ar reassessment scheduled or completed
  Document the next reassessment time or confirm the post-medication reassessment was completed.
• Escalation actions documented
  Record actions such as provider notification, transfer to higher level of care, increased monitoring, seizure precautions, or safety observation.