Alcohol Behavior and Traumatic Injury: Implementing a Screening and Brief Intervention Program

2.50
Hdl Handle:
http://hdl.handle.net/10755/162672
Type:
Presentation
Title:
Alcohol Behavior and Traumatic Injury: Implementing a Screening and Brief Intervention Program
Abstract:
Alcohol Behavior and Traumatic Injury: Implementing a Screening and Brief Intervention Program
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Rossie, Julie, RN, MS, CNS, CCRN
P.I. Institution Name:Regional Medical Center San Jose
Title:Trauma Clinical Nurse Specialist and Injury Prevention Coordinator
Contact Address:225 N. Jackson Ave, San Jose, CA, 96116, USA
Contact Telephone:(408) 272-6492
Co-Authors:Linda Raby, RN, BSN, CCRN; Garrett Chan, APRN, BC, PhD, CEN
[Injury Prevention Poster] Injury Prevention Topic: Alcohol use is a major risk factor for multiple categories of injury in the United States. Alcohol-related trauma can function as a "crisis" that facilitates the identification of a drinking problem and consequent reduction in drinking behavior. Brief intervention (BI) provided in the emergency department (ED) capitalizes on this "teachable moment." Research demonstrates that BI programs reduce alcohol intake, binge drinking, and driving under the influence, thereby reducing alcohol-related ED admissions. In 2005, this Level II trauma center, with 1,864 patient visits a year, reviewed trauma registry data and found positive blood alcohol (BA) levels for 28% of patients tested. The purpose of this project was to develop an alcohol screening and BI program designed to reduce alcohol-related behavior and concomitant recidivism rates in the emergency department.

Implementation: A multidisciplinary task force met twice a month for three months to identify, which tool or tools to use for screening, the process for screening, and provision of BI, based on a literature review conducted by the trauma clinical nurse specialist (CNS). Blood alcohol level screening and the CAGE questionnaire (with additional questions on alcohol consumption levels) were chosen. ED trauma flow record and admission electronic record were updated to incorporate CAGE questions. Patient education and referral materials, printed in English, Spanish, and Vietnamese also were developed. Staff education included presentations at staff and management meetings. A kick-off celebration boosted awareness, and the program was implemented March 2006. The new protocol calls for obtaining BA levels shortly after arrival in the emergency department. BA levels of 80mg/dL or greater are considered a positive screening, regardless of responses to the CAGE, and CAGE screening is considered positive, irrespective of BA levels under the following conditions: if patients answered "yes" to two or more questions; if male patients consumed more than 14 drinks in a week or more than four drinks on a single occasion; if female patients consumed more than seven drinks in a week or more than three drinks on a single occasion; and if patients were 65 years or older. Nurses administered the questionnaire to all trauma patients, as soon as the patient's condition allowed. Positive screens, whether BA or CAGE, were referred for BI with social services staff members, who reviewed the patient's answers to the questionnaire and results of the BA, where appropriate. Patients also received educational brochures and treatment referrals, as appropriate. Nursing staff provided BI during social worker off hours. Monthly evaluations of charts by the trauma CNS, periodic reminders, and updates of outcome data encouraged compliance among nursing staff and social workers.

Outcomes: Of 1,234 patients screened between March 2006 to December 2006; 282 (84% males, 16% females) tested positive for at-risk alcohol-related behavior. Of these, 15% were teenagers or under-age drinkers 14-20 years; 54% were 21 to 35 years; 29% were 36-64 years; and 2% were age 65 or above. Although 52% of patients with a positive screen received BI in the initial month of the program, the rate for each of the three subsequent months declined to 19%, 30% and 23%, respectively. However, with staff retraining and follow-up by the trauma CNS, BI rates have gradually improved, reaching 46% by July and 61% by December. To reach our goal of 90% compliance, measures are being taken to ensure BI proceeds at time of ED discharge, even when social workers are off duty. Patient response has been positive. Many express willingness to reduce alcohol consumption to acceptable levels and seek assistance, if appropriate. Staff, too, report overall satisfaction with the program; previously, they had expressed concern that the emergency department did not adequately address alcohol consumption in trauma patients.

Recommendations: Emergency departments provide a unique setting for the detection of high-risk alcohol-related behavior and subsequent patient intervention and referral. Emergency nurses can play a key role in initiating alcohol screening and brief intervention programs designed to achieve these goals. Such programs are inexpensive and assimilate easily into existing ED patient care. Expanding these programs to non-trauma patient populations may also identify hidden at-risk patients and should be considered. Identification and early intervention for high-risk alcohol behavior, regardless of ED presentation, can potentially impact subsequent injury.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAlcohol Behavior and Traumatic Injury: Implementing a Screening and Brief Intervention Programen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162672-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Alcohol Behavior and Traumatic Injury: Implementing a Screening and Brief Intervention Program</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Rossie, Julie, RN, MS, CNS, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Regional Medical Center San Jose<br/></td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Trauma Clinical Nurse Specialist and Injury Prevention Coordinator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">225 N. Jackson Ave, San Jose, CA, 96116, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(408) 272-6492</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">julie.rossie@hcahealthcare.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Linda Raby, RN, BSN, CCRN; Garrett Chan, APRN, BC, PhD, CEN</td></tr><tr><td colspan="2" class="item-abstract">[Injury Prevention Poster] Injury Prevention Topic: Alcohol use is a major risk factor for multiple categories of injury in the United States. Alcohol-related trauma can function as a &quot;crisis&quot; that facilitates the identification of a drinking problem and consequent reduction in drinking behavior. Brief intervention (BI) provided in the emergency department (ED) capitalizes on this &quot;teachable moment.&quot; Research demonstrates that BI programs reduce alcohol intake, binge drinking, and driving under the influence, thereby reducing alcohol-related ED admissions. In 2005, this Level II trauma center, with 1,864 patient visits a year, reviewed trauma registry data and found positive blood alcohol (BA) levels for 28% of patients tested. The purpose of this project was to develop an alcohol screening and BI program designed to reduce alcohol-related behavior and concomitant recidivism rates in the emergency department.<br/><br/>Implementation: A multidisciplinary task force met twice a month for three months to identify, which tool or tools to use for screening, the process for screening, and provision of BI, based on a literature review conducted by the trauma clinical nurse specialist (CNS). Blood alcohol level screening and the CAGE questionnaire (with additional questions on alcohol consumption levels) were chosen. ED trauma flow record and admission electronic record were updated to incorporate CAGE questions. Patient education and referral materials, printed in English, Spanish, and Vietnamese also were developed. Staff education included presentations at staff and management meetings. A kick-off celebration boosted awareness, and the program was implemented March 2006. The new protocol calls for obtaining BA levels shortly after arrival in the emergency department. BA levels of 80mg/dL or greater are considered a positive screening, regardless of responses to the CAGE, and CAGE screening is considered positive, irrespective of BA levels under the following conditions: if patients answered &quot;yes&quot; to two or more questions; if male patients consumed more than 14 drinks in a week or more than four drinks on a single occasion; if female patients consumed more than seven drinks in a week or more than three drinks on a single occasion; and if patients were 65 years or older. Nurses administered the questionnaire to all trauma patients, as soon as the patient's condition allowed. Positive screens, whether BA or CAGE, were referred for BI with social services staff members, who reviewed the patient's answers to the questionnaire and results of the BA, where appropriate. Patients also received educational brochures and treatment referrals, as appropriate. Nursing staff provided BI during social worker off hours. Monthly evaluations of charts by the trauma CNS, periodic reminders, and updates of outcome data encouraged compliance among nursing staff and social workers.<br/><br/>Outcomes: Of 1,234 patients screened between March 2006 to December 2006; 282 (84% males, 16% females) tested positive for at-risk alcohol-related behavior. Of these, 15% were teenagers or under-age drinkers 14-20 years; 54% were 21 to 35 years; 29% were 36-64 years; and 2% were age 65 or above. Although 52% of patients with a positive screen received BI in the initial month of the program, the rate for each of the three subsequent months declined to 19%, 30% and 23%, respectively. However, with staff retraining and follow-up by the trauma CNS, BI rates have gradually improved, reaching 46% by July and 61% by December. To reach our goal of 90% compliance, measures are being taken to ensure BI proceeds at time of ED discharge, even when social workers are off duty. Patient response has been positive. Many express willingness to reduce alcohol consumption to acceptable levels and seek assistance, if appropriate. Staff, too, report overall satisfaction with the program; previously, they had expressed concern that the emergency department did not adequately address alcohol consumption in trauma patients.<br/><br/>Recommendations: Emergency departments provide a unique setting for the detection of high-risk alcohol-related behavior and subsequent patient intervention and referral. Emergency nurses can play a key role in initiating alcohol screening and brief intervention programs designed to achieve these goals. Such programs are inexpensive and assimilate easily into existing ED patient care. Expanding these programs to non-trauma patient populations may also identify hidden at-risk patients and should be considered. Identification and early intervention for high-risk alcohol behavior, regardless of ED presentation, can potentially impact subsequent injury.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:11Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:11Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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