Paper: Alcohol Related Issues: The Process behind Evidence-Based Practice Improvement (40th Biennial Convention (October 31st- November 4th, 2009))

Sunday, November 1, 2009

Andrea L. Williams, RN, PhD
Trauma & Emergency Education Centers, UW School of Nursing, University of Wisconsin Hospital & Clinics, University of Wisconsin, Madison, Madison, WI
Lynnda Zibell Milsap, MS
Nursing-Psychiatry, University of Wisconsin Hospital & Clinics, Madison, WI

Learning Objective 1: define the elements of evidence based practice underpinning the University of Wisconsin Hospital & Clinics and American Family Childrens Hospital's alcohol related issues program.

Learning Objective 2: identify the organizational components to implement evidence based practice changes (alcohol screening measures, brief intervention, and follow-up)in a tertiary care facility.

Evidence has been mounting that health care facilities must change clinical practice to improve outcomes and prevent recidivism related to alcohol related issues.¹All you have to do is go to a high school or college football game to realize the scope of the problem. Over seven million teenagers binge drink. Heavy alcohol consumption is present in 2.3 million adults in the United States.² The Emergency Nurses Association Injury Prevention Institute, American College of Surgeons Committee on Trauma, Centers for Disease Control and Prevention, National Institute on Alcohol Abuse and Alcoholism, Substance Abuse and Mental Health Services and the Department of Transportation’s National Highway Traffic Safety Administration have developed position papers, guidelines, verification criterion and/or programs to better screen for alcohol risks, provide evidence-based interventions, referrals and treatments for patients admitted to our emergency departments, ambulatory or inpatient settings with alcohol related issues.^{3, 4}

Delegates from the Nursing Council at the University of Wisconsin Hospital & Clinics and American Family Children’s Hospital in conjunction with the Center for Addictive Disorders and Level One Trauma Center Team, developed evidence based Nursing Practice Guidelines for alcohol related issues; adopted national/international reliable and valid alcohol screening practices (CAGE + Consumption and CRAFFT);^{5, 6} adopted the Clinical Institute Withdrawal Assessment (CIWA-AR) for withdrawal; implemented brief interventions for patients screening positive for at risk or dependent drinkers;⁷ developed a call-back system for follow-up; and designed the programmatic changes to coincide with implementation of the electronic medical record and CPOE. Implementing the changes during Electronic medical record Go-Live ensured that compliance data and information for problem identification and program improvement would be readily available. A diverse nursing practice team was formed for the development of the alcohol related evidence-based nursing practice guideline. An interdisciplinary team composed of nurses, physicians, case/outcomes managers, pharmacists, administrators and information service personnel recommended CIWA-Ar and developed the order sets for symptom triggered interventions. Evidence gathered in the development of the Nursing Practice Guideline for Alcohol Related Issues drove changes in practice including methods for alcohol screening, treatment, referral, brief intervention, and follow-up. University of Wisconsin Hospital and Clinics and the University of Wisconsin American Family Children’s Hospital health care personnel received education to implement the alcohol related issues changes and now document these practices through the Health Link electronic medical record. Data is being collected to determine the effectiveness of these changes to better screen, appropriately intervene, and to prevent escalation of withdrawal and recidivism.

See more of: Accepted EBP Posters
See more of: Oral Paper & Poster: Evidence-Based Practice Contest