Educating Emergency Department Registered Nurses (EDRNs) in screening, brief intervention, and referral to treatment (SBIRT): Changes in attitudes and knowledge over time

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Highlights

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    SBIRT has been shown to be effective in reducing risky alcohol consumption.

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    Patients trust nurses, underscoring nurses’ ability to have a positive impact.

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    EDRNs can increase their knowledge and attitudes to routinely screen patients for risky substance use.

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    SBIRT training and educational reinforcement is key for continued implementation.

Abstract

Alcohol and other drug (AOD) diagnoses in the ED co-occur with injury-related presenting conditions including: falls, motor vehicle accidents, poisonings, and both intentional and unintentional injuries. Clinical attention to ED admissions resulting from hazardous AOD use can significantly improve patient care and reduce high cost utilization of ED visits and treatment. The EDRN-SBIRT project is designed to improve the knowledge and attitudes of ED nurses working in a large academic medical center to identify and address risky AOD use as it relates to an ED visit. ED nurses’ knowledge and attitudes toward patients with AOD use can be improved through SBIRT education. SBIRT education can establish an evidence-based standard of nursing practice to improve healthcare outcomes, but it must be reinforced with ongoing ED review and supportive educational sessions until practice is firmly established.

Introduction

The advent of healthcare reform has focused national attention on preventable emergency department (ED) admissions and hospital readmissions for chronic disorders. Clinical attention to ED admissions resulting from hazardous alcohol and other drug (AOD) use can significantly improve patient care and reduce high cost utilization of ED visits and treatment.

One million ED visits involved prescription drugs, especially opioid painkillers and benzodiazepines, or over-the-counter drugs used non-medically, while another million visits involved illicit drugs, primarily cocaine and heroin, according to the Centers for Disease Control and Prevention [1]. The percentage of ED patients presenting with nondependent use of alcohol, alcohol dependence, alcoholic psychoses, or any other alcohol-related diagnosis has increased each year from 2006 to 2011 [2]. One quarter of ED visits for drug use or misuse also involved the use of alcohol [3]. Clearly, a significant opportunity exists for ED nurses to identify, address, and reduce the risks of AOD use during an ED visit [4], [5].

Recognizing the opportunity for innovation in ED care, a team at The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addicitions, developed an educational training program to build interprofessional collaborative skills among ED Registered Nurses (EDRNs) to address patients’ hazardous AOD use. EDRNs within five hospitals of a large academic medical center healthcare system were trained and supported to implement and sustain the evidence-based practice of screening, brief intervention, and referral to treatment (SBIRT) [6]. While this paper will briefly describe the rationale for the project, the training curriculum, and implementation approach; the focus is on the results of the EDRN-SBIRT intervention, specifically examining changes in attitudes and knowledge of all trained ED staff as a result of the SBIRT education intervention.

Section snippets

Background

Alcohol and other drug (AOD) diagnoses in the ED co-occur with injury-related presenting conditions including: falls, motor vehicle accidents, poisonings, and both intentional and unintentional injuries [7], [2]. These AOD-related visits amount to a total estimated public cost of substance use in the United States of approximately $510.8 billion annually [8]. A report on ED visits in 2007 revealed one fifth of the civilian, non-institutionalized population in the United States had at least one

EDRN-SBIRT project

The EDRN-SBIRT project, specifically designed to improve the attitudes and knowledge of EDRNs is timely. The American College of Surgeons’ Committee on Trauma (ACS-COT) recently established requirements to address the need for screening and brief intervention in the ED, requiring Level I and Level II trauma centers to have a mechanism to identify people who may have a problem with their drinking. Additionally, Level I trauma centers are required to have the capability to provide brief

Participants

Participants in this study were 62 ED nurses and other staff working in one of the five EDs of an academic medical center healthcare system that participated in the SBIRT educational and skill building program. The majority of the ED staff was female (n = 51, 83.6%) and white (n = 59, 95.1%). The mean age for the ED staff was 43 years (range 22–70 years). Detailed demographics by site are shown in Table 1.

Instruments

The instruments selected to measure ED staff attitudes and perceptions while working with

Results

On the AAPPQ, significant effects across time points were found for all subscales with the exception of Task-Specific Self Esteem (See Table 2). Post-hoc tests revealed that for Role Adequacy and Role Support, the overall difference was explained by the increase from pre-training to post-training (Role Adequacy, p < 0.01, 95% CI −0.53, −0.27; Role Support, p < 0.01, 95% CI −0.067, −0.35). These increases were sustained at the 30-day follow up period; no significant difference from post-training to

Discussion

Nearly all the subscales on both the AAPPQ and DDPPQ increased significantly from pre-training to post-training, indicating that overall attitudes toward working with patients with AOD use improved as a result of the SBIRT education program and SBIRT practice. Further, Role Adequacy, defined as the perception that one is able to perform the role of talking with patients about their use; and Role Support, defined as the perception of support that would be available from supervisors and

Conclusions

This study supports the Desy and Perhats [29] call for emergency nurses’ perspective and expertise to be part of SBIRT implementation and to allow EDRNs to define their role and develop feasible goals for SBIRT in the ED. SBIRT education can establish an evidence-based standard of nursing practice to improve healthcare outcomes in this quality outcome, finance-conscious era, but this education must be reinforced with ongoing ED review and supportive educational sessions until practice is firmly

Funding acknowledgement

This project received support in part by funds from the Division of Nursing (DN), Bureaus of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D11HP22206 titled, Emergency Department Registered Nurses and Screening, Brief Intervention, and Referral to Treatment (EDRN-SBIRT). The information or content and conclusions are those of the authors and should not be construed as the official position or

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