Emergency Nurses Address Substance Use in the Rural Hospital

Monday, 18 November 2013: 10:00 AM

Irene Kane, PhD, MSN, RN, CNAA, HFI1
Ann M. Mitchell, PhD, RN, FAAN1
Kimberly Owens, MSN, BSN, CS2
Laurie Christy, RN2
Dawn Lindsay, PhD3
Kathryn Puskar, DrPH, MN, MPH, FAAN1
Kimberly Talcott, MPA1
James L. Aiello, MA, MEd4
Martin P Houze, MA5
Holly Hagle, MA3
Lynn O. Boucek, BSN6
(1)School of Nursing, University of Pittsburgh, Pittsburgh, PA
(2)Western Psychiatric Institute and Clinic, Pittsburgh, PA
(3)Institute for Research, Education, and Training in Addictions, Pittsburgh, PA
(4)Institute for Research, Education and Training in Addictions, Pittsburgh, PA
(5)Center for Research and Evaluation, University of Pittsburgh School of Nursing, Pittsburgh, PA
(6)University of Pittsburgh School of Nursing, Pittsburgh, PA

Learning Objective 1: Describe screening, brief intervention, and referral to treatment (SBIRT) evidence-based nursing practice in the rural ED setting.

Learning Objective 2: Identify how the screening, brief intervention, and referral to treatment (SBIRT) process can benefit patient-centered care in their ED setting.

Background: Rural emergency departments (EDs) offer strategic opportunities to screen and intervene with underserved patients for high-risk alcohol and other drug use (AOD) associated with immediate/ long-term health problems necessitating the ED visit. Nationally, over 23.1 million individuals aged 12 and older need substance use treatment, but less than 10% receive treatment. Emergency department registered nurses (EDRNs) can readily assess patients for high-risk substance use through implementing the evidence-based screening, brief intervention, and referral to treatment (SBIRT) program.  

Methods: University of Pittsburgh School of Nursing partnered with a rural sole-provider community hospital (14,135 annual ED visits) and trainers from a non-profit training institute to teach SBIRT to 16 EDRNs, 6 ICU RNs (ED rotate), 4 supervisors, 2 MDs, 9 ED staff. Face-to-face training sessions followed by an online course review, one-on-one booster guidance, and nurse champion development comprised the program focused on developing patient-centered knowledge and skills to improve quality of care for patients whose AOD use may not warrant specialized professional care, but require earlier identification along the continuum of substance use, abuse, dependence to prevent major health complications.

Results: Outcome data indicate EDRNs and other staff responded positively to the training with significant perceptions and knowledge improvement from pre-training to post-training as reported on the Alcohol and Alcohol Problems Perceptions Questionnaire, Drug and Drug Problems Perceptions Questionnaire, and the SBIRT Knowledge Scale. Qualitative data indicated EDRNs and staff retained basic SBIRT knowledge, but documenting the SBIRT process requires additional informatics upgrades.  

Conclusions and Implications for Nursing Practice: Incorporating SBIRT into rural sole-provider hospitals offers opportunities for EDRNs to identify AOD use and briefly intervene to divert problematic use before specialty care is required. Further, the improved quality of ED patient-centered SBIRT care for this rural population provides compliance with newly proposed hospital addictions Joint Commission screening performance measures.