Implementing Interprofessional Alcohol SBIRT in the Emergency Department
Vicki Bacidore, DNP, APN, ACNP-BC, CEN
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Session F presented Friday, September 15, 2017
Purpose: Alcohol misuse is one of the leading causes of illness, disease, injury and death in the Unites States. For many patients, the Emergency Department (ED) visit may provide the only therapeutic opportunity to influence problematic drinking behavior. Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based approach that may reduce alcohol-related morbidity and mortality, and improve health outcomes and quality of life. The purpose of this project was to develop, deliver, and evaluate an interprofessional education program on alcohol SBIRT, and implement the SBIRT protocol in the ED.
Design: A quasi-experimental design, single-sample, non-randomized cohort was used for this QI project.
Setting: A large academic Level I trauma center.
Participants/Subjects: All ED nurses and social workers and all ED patients meeting inclusion criteria: agrees to be screened; >18 years of age; English-speaking; GCS of 15; and triage score of 3, 4, or 5.
Methods: The educational module was developed and delivered via the hospital’s E-learning management system. Ten multiple-choice pretest/posttest questions were written based on the content of the educational module. To establish content validity an expert panel was engaged to rate the relevance of each question using the Scale Content Validity Index average. Internal consistency was measured using Cronbach’s alpha. A paired sample t-test was done to note the differences between the total pretest and posttest scores. A 4-point Likert scale program evaluation form evaluated the achievement of objectives and the relevance of the program. The alcohol SBIRT screening and documentation protocol was placed in the EHR. Non-parametric descriptive statistics were collected on the ED patients.
Results/Outcomes: The S-CVI/Ave was 1.00 for the pretest/posttest. Internal consistency was established via a Cronbach’s alpha coefficient of .95. Sixty-nine nurses (86%) and four (100%) social workers completed the module. Pretest scores ranged from 20%-100% (M=57.31; SD=15.13). Posttest scores ranged from 80%-100% (M=90.9; SD=8.48). Results revealed a statistically significant difference (t 66)=15.9, p< .001) between the pretest and posttest scores. Ninety-eight percent of the nurses (n=69) and 100% of the social workers (n=4) reported the objectives were met to a moderate/great extent and the program was relevant/impactful to practice. 2,531 ED patient charts were reviewed. 869 patients (34%), refused screening. 1,144 patients (45%), didn't meet inclusion criteria. 518 patients (21%) were screened. 478 patients (92%), screened negative and 40 patients (8%), screened positive. Of those positively screened, 18 patients (45%), were admitted to the Trauma Service to receive in-patient SBIRT and 22 patients (55%), received ED SBIRT. Mean patient age was 43 years with (80%) males. Twenty-seven patients (68%), had harmful drinking scores. 13 patients (32%) had possible dependence scores. Chief complaints were: trauma (63%), musculoskeletal (15%), behavioral/substance abuse (15%), and abdominal pain (7%). 100% of the nurses/social workers documented the protocol components in the EHR.
Implications: ED nurses and social workers can commit to the inclusion of SBIRT education and protocol as a quality improvement process, promoting SBIRT as a standard of care. Further study can include follow-up with patients after referral to treatment, to garner information on clinical outcomes.
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