SHM Converge Scientific Abstract ePoster Gallery-Phenobarbital for the Management of Alcohol Withdrawal in a Rural Hospital

Pdf Summary

This poster describes a quality improvement project to increase the use of phenobarbital for alcohol withdrawal syndrome (AWS) at Mountain West Medical Center, a rural hospital affiliated with the University of Utah. AWS is a common and potentially severe complication of alcohol use disorder, and benzodiazepines have traditionally been the standard treatment. However, phenobarbital is increasingly recognized as a safe and effective alternative, including as first-line therapy.<br /><br />The project aimed to improve provider education and comfort with weight-based phenobarbital loading doses, especially 10 mg/kg, and to increase uptake in the emergency department and inpatient setting. The team identified barriers specific to the rural environment, including unfamiliarity with phenobarbital, concerns about respiratory depression, and uncertainty about whether hospitalists would accept patients treated with it in the ED.<br /><br />To address these issues, a multidisciplinary working group was formed with ED physicians, hospitalists, pharmacy, nursing, and patient safety stakeholders. The team reviewed existing AWS protocols from both institutions, gathered provider feedback, and created a new collaborative phenobarbital protocol and electronic health record order set. Monthly PDSA cycles were used to refine the process, address barriers, and support ongoing education.<br /><br />Education sessions were held separately for ED and hospitalist teams, focusing on phenobarbital safety, pharmacokinetics, the rationale for weight-based dosing, and contraindications. Provider feedback showed that many clinicians had limited prior experience with phenobarbital, and hospitalists in particular were hesitant about loading doses because of airway management concerns.<br /><br />The poster concludes that implementing evidence-based protocols in rural hospitals is facilitated by collaboration with academic medical centers. It also highlights the importance of strong coordination between ED and inpatient teams when a treatment spans both settings.

Asset Subtitle

Isadore Dodard Friedman

Meta Tag

Author List Devin J. Horton, Isadore Dodard Friedman, Madeline Bernardo

Category Innovations

Concept Alcohol Withdrawal

Concept Phenobarbital

Concept Rural Health Care

Concept Respiratory Depression

Concept Clinical protocol

Distinguished Non-Finalist

Presenter Organization University of Utah Health

Presenting Author Isadore Dodard Friedman

Track Translating Research into Practice

Keywords

phenobarbital

alcohol withdrawal syndrome

quality improvement

rural hospital

weight-based dosing

provider education

emergency department

hospitalist collaboration

electronic health record order set

PDSA cycle

Alcohol Withdrawal

Phenobarbital

Rural Health Care

Respiratory Depression

Clinical protocol

Devin J. Horton, Isadore Dodard Friedman, Madeline Bernardo

Innovations

Non-Finalist

University of Utah Health

Isadore Dodard Friedman

Translating Research into Practice