Maintaining Emergency Room Nurse Momentum to Screen for Substance Use

Purpose: Substance use is a worldwide public-health priority. Annually, 2.5 million die from the harmful use of alcohol (World Health Organization (WHO) 2011 Global Status Report).   WHO also reports that at least 15.3 million persons have drug use disorders (WHO, 2014).  Risks associated with use of alcohol and other drugs can lead to accidents, violent behavior, and societal/developmental issues.  To address substance use risks, an interprofessional (academic-community-health provider) partnership trained Emergency Department Registered Nurses (EDRNs) to utilize an evidence-based practice (Screening, Brief Intervention and Referral to Treatment: SBIRT) to screen patients for substance misuse for timely brief interventions enhancing motivation to reduce use or follow-up on assessment referral.  To maintain SBIRT momentum by busy EDRNs, Nurse Champions were appointed who, with the ED Nurse Manager, play a critical role in coordinating ongoing SBIRT educational updates and quality outcomes and maintain a consult liaison with EDRN interprofessional trainers.

Methods: During the SBIRT training of EDRNs in four hospitals located in urban, rural, and low-income areas, nurse champions: 1) observed and participated in the evidence-based content, teaching/ practice skills, and discussion sessions; and, 2) consulted with EDRN interprofessional trainers for SBIRT maintenance via ED manual development, online programming, educational posters and consultative return visits.  

Results: Overall, staff RNs demonstrated high rates of effectively engaging patients in the SBIRT process, with 91% conducting effective screens, 73% engaging patients in a negotiated interview, and 70% collaborating with patients to determine next steps. The most frequently cited reasons for not engaging in SBIRT was lack of relevancy to the patient population at the screening stage (N=4), difficulty in connecting use to a patient’s presenting health problem at the brief intervention stage (N=3), because they felt a referral was not necessary (N=2), and waiting to collaborate with a behavioral health/ mental health/ social work colleague at the brief interview (N=1) or referral stage (N=2). Personal discomfort was cited as a reason for not engaging in SBIRT by only two individuals.

Conclusion: EDRN SBIRT education promotes patients’ need for intervention to be identified earlier along the continuum of use, abuse, and dependence. However, support for a busy EDRN to maintain developing SBIRT skills is critical to practice maintenance. The Nurse Champion role reinforces learning through encouraging and fostering emergent evidence-based SBIRT practice.