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Ambulatory Management
Monitoring
Frequency:
• Arrange for daily check-in for up to five days
• If can't attend daily, alternating in-person visits with remote check-ins via phone
or video call may be appropriate
Assess:
• Withdrawal severity using validated scale
• Vital signs
• Orientation, sleep and emotional status including suicidal thoughts
• If taking withdrawal medication, signs of over-sedation
• Continued alcohol or other substance use
Consider Transfer to More Intensive Level of Care if:
Worsening withdrawal severity
Worsening medical or psychiatric problems
Agitation or severe tremor despite multiple doses of medication
Over-sedation
Return to alcohol use
Syncope, unstable vital signs (low/high blood pressure, low/high heart rate)
Supportive Care
Advise patients and caregivers regarding :
• Common signs and symptoms and how they will be treated
• Identifying signs of worsening symptoms
• Taking thiamine, multivitamins, staying hydrated
• Creating a low-stimulation environment at home
• Importance of taking medications as prescribed
• Possible need to transfer if ambulatory management is not safe or effective
Treat other conditions found during initial assessment or follow-up with Primary Care
Pharmacotherapy
See Pharmacotherapy Protocol
AUD Treatment Engagement
As cognitive status permits:
• Initiate AUD treatment, including medications for AUD (e.g., acamprosate,
disulfiram, or naltrexone) if appropriate, or refer to a qualified provider
Ongoing Care (Follow-up)
AUD treatment:
• If not initiated, provide referral for AUD treatment and counseling
• If initiated, arrange ongoing prescription for AUD medications
Medical care:
• Advise follow-up with Primary Care regarding unresolved conditions found
during initial assessment
