Date of Conferral

8-21-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Diane Whitehead

Abstract

Alcohol withdrawal syndrome (AWS) is a critical condition commonly encountered in hospital settings. If not properly treated, AWS can progress to seizures, delirium tremens, and death. Traditionally, benzodiazepines guided by the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar), have served as a mainstay of treatment. However, emerging evidence supports the use of phenobarbital as a pharmacologic alternative and the Severity of Ethanol Withdrawal Scale (SEWS) as a more objective and clinically practical assessment tool. This doctor of nursing practice (DNP) project aimed to develop an evidence-based clinical practice guideline (CPG) for the use of phenobarbital in managing severe AWS and to replace the CIWA-Ar with the SEWS for clinical assessment. Following the development of the guideline, its quality and applicability were appraised by an expert panel of five interprofessional health care providers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores across the six AGREE II domains ranged from 6.0 to 6.6 out of 7, indicating high quality, clarity, and relevance. By replacing the CIWA-Ar with the SEWS and implementing a standardized phenobarbital protocol, this project has the potential to promote timely intervention, improve safety in nonverbal or critically ill patients, and support consistency in treatment practices across units and hospitals. Implementation of this evidence-based updated guideline may promote positive social change for patients, families, and staff, with anticipated improvement in patient outcomes, including fewer intensive care unit (ICU) transfers and reduced symptom escalation.

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