Identifying High-Risk Alcohol Trauma Patient: Developing an Emergency Department Screening and Intervention Tool

2.50
Hdl Handle:
http://hdl.handle.net/10755/162675
Type:
Presentation
Title:
Identifying High-Risk Alcohol Trauma Patient: Developing an Emergency Department Screening and Intervention Tool
Abstract:
Identifying High-Risk Alcohol Trauma Patient: Developing an Emergency Department Screening and Intervention Tool
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:St. John, Wendy, RN, BSN
P.I. Institution Name:Wishard Health Services
Title:Assistant Trauma Program Manager
Contact Address:1001 West 10th Street, MY 1014, Indianapolis, IN, 46202, USA
Contact Telephone:(317) 630-2612
Co-Authors:Heather Kemp, BA; Theresa Joy, RN, BSN, CEN; Gerardo Gomez, MD, FACS
[Injury Prevention Poster] Injury Prevention Topic: As many as 47% of all injury patients presenting to emergency departments (EDs) in the United States are associated with high-risk alcohol use. High-risk alcohol use is defined as more than five standard drinks on any given day, or more than two drinks on six or seven days in a week. The American College of Surgeons (ACS) recently made it a requirement for ACS-verified Level I trauma centers to screen all trauma patients for high-risk alcohol use and provide intervention to patients with elevated blood alcohol levels. In July 2005, this Midwest urban Level I trauma center developed an alcohol screening and intervention protocol. The purpose of this study was to evaluate staff compliance with the program's algorithm, to ensure all trauma patients received screening and, where appropriate, brief intervention (BI).

Implementation: In April 2005, trauma, psychiatry, and outpatient substance abuse treatment staff formed a task force to develop an alcohol screening and intervention program. After studying current research findings and consulting with alcohol-related trauma experts, the task force implemented a pilot screening and intervention program in July 2005. The screening portion of the algorithm called for obtaining a blood alcohol concentration (BAC) and administration of the Alcohol Use Disorders Test-Consumption (AUDIT-C) survey by a trauma nurse during patient rounds for all ED patients. A BAC value above the legal limit of >80 mg/dL or an AUDIT-C score of >3 for women, or >4 for men identified patients as positive for high-risk alcohol use. The protocol required these patients to receive a 5- to 10-minute BI conducted by a trained team member. The BI consisted of reviewing AUDIT-C test scores with the patient, stressing the importance of reducing alcohol intake, discussing a plan to achieve this, and providing referrals.

Outcomes: Of 346 trauma patients arriving in the emergency department between July 2005 and October 2005, only 13% (n = 44) completed both the BAC and AUDIT-C; 23% of all patients completed the AUDIT-C but not the BAC (n=79) and 51% (n = 177) had a BAC lab drawn on arrival, but not an AUDIT-C. Only 45% (n=20) of patients completing both portions of the protocol tested positive for high-risk alcohol use, with 20% (n = 4) identified solely by their answers on the AUDIT-C, and 80% identified either by BAC alone (n = 11) or BAC and AUDIT-C combined (n = 5). Because the BAC alone was sufficient to identify high-risk alcohol use, we have since eliminated the AUDIT-C from our protocol. The BAC is now the sole screening tool and a standing order for all trauma patients. Subsequent reviews of the data revealed that BAC compliance was higher than AUDIT-C compliance because BAC is drawn along with other labs without adding to ED staff workload. Subsequent consultation with field experts affirmed that high compliance rates for questionnaires can only be achieved where funding is available for a full-time employee dedicated to this task. Guided by these results, psychiatry staff has begun training ED staff and nurses from the other units (intensive care, medical/surgical) to boost BI compliance. The protocol now requires that inpatient substance abuse consultations be ordered for consenting patients, as indicated after BI. Two intensive on-site BI training sessions were conducted in January 2006, which has dramatically increased the number of staff qualified to perform a BI. Additionally, BI training for surgery residents rotating on the trauma service was instituted. Since then, a review of data for 183 trauma patients treated from November 2006 through January 2007, showed significant increases in compliance (62% for BAC screening and 25% for BI).

Recommendations: One approach to reducing the number of injuries presenting to the emergency department has been to screen trauma patients for high-risk alcohol use and provide brief intervention when warranted. However, even when screening protocols are in place, staff compliance must be assessed intermittently. A lack of training in intervention and heavy workloads often prevent staff from implementing screening procedures. Reviewing patient records to determine compliance is a key step. Future plans include collaboration with psychiatry staff to review outcomes of inpatient referrals.
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.titleIdentifying High-Risk Alcohol Trauma Patient: Developing an Emergency Department Screening and Intervention Toolen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162675-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Identifying High-Risk Alcohol Trauma Patient: Developing an Emergency Department Screening and Intervention Tool</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">St. John, Wendy, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Wishard Health Services</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Trauma Program Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1001 West 10th Street, MY 1014, Indianapolis, IN, 46202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(317) 630-2612</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">wendy.stjohn@wishard.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Heather Kemp, BA; Theresa Joy, RN, BSN, CEN; Gerardo Gomez, MD, FACS</td></tr><tr><td colspan="2" class="item-abstract">[Injury Prevention Poster] Injury Prevention Topic: As many as 47% of all injury patients presenting to emergency departments (EDs) in the United States are associated with high-risk alcohol use. High-risk alcohol use is defined as more than five standard drinks on any given day, or more than two drinks on six or seven days in a week. The American College of Surgeons (ACS) recently made it a requirement for ACS-verified Level I trauma centers to screen all trauma patients for high-risk alcohol use and provide intervention to patients with elevated blood alcohol levels. In July 2005, this Midwest urban Level I trauma center developed an alcohol screening and intervention protocol. The purpose of this study was to evaluate staff compliance with the program's algorithm, to ensure all trauma patients received screening and, where appropriate, brief intervention (BI).<br/><br/>Implementation: In April 2005, trauma, psychiatry, and outpatient substance abuse treatment staff formed a task force to develop an alcohol screening and intervention program. After studying current research findings and consulting with alcohol-related trauma experts, the task force implemented a pilot screening and intervention program in July 2005. The screening portion of the algorithm called for obtaining a blood alcohol concentration (BAC) and administration of the Alcohol Use Disorders Test-Consumption (AUDIT-C) survey by a trauma nurse during patient rounds for all ED patients. A BAC value above the legal limit of &gt;80 mg/dL or an AUDIT-C score of &gt;3 for women, or &gt;4 for men identified patients as positive for high-risk alcohol use. The protocol required these patients to receive a 5- to 10-minute BI conducted by a trained team member. The BI consisted of reviewing AUDIT-C test scores with the patient, stressing the importance of reducing alcohol intake, discussing a plan to achieve this, and providing referrals.<br/><br/>Outcomes: Of 346 trauma patients arriving in the emergency department between July 2005 and October 2005, only 13% (n = 44) completed both the BAC and AUDIT-C; 23% of all patients completed the AUDIT-C but not the BAC (n=79) and 51% (n = 177) had a BAC lab drawn on arrival, but not an AUDIT-C. Only 45% (n=20) of patients completing both portions of the protocol tested positive for high-risk alcohol use, with 20% (n = 4) identified solely by their answers on the AUDIT-C, and 80% identified either by BAC alone (n = 11) or BAC and AUDIT-C combined (n = 5). Because the BAC alone was sufficient to identify high-risk alcohol use, we have since eliminated the AUDIT-C from our protocol. The BAC is now the sole screening tool and a standing order for all trauma patients. Subsequent reviews of the data revealed that BAC compliance was higher than AUDIT-C compliance because BAC is drawn along with other labs without adding to ED staff workload. Subsequent consultation with field experts affirmed that high compliance rates for questionnaires can only be achieved where funding is available for a full-time employee dedicated to this task. Guided by these results, psychiatry staff has begun training ED staff and nurses from the other units (intensive care, medical/surgical) to boost BI compliance. The protocol now requires that inpatient substance abuse consultations be ordered for consenting patients, as indicated after BI. Two intensive on-site BI training sessions were conducted in January 2006, which has dramatically increased the number of staff qualified to perform a BI. Additionally, BI training for surgery residents rotating on the trauma service was instituted. Since then, a review of data for 183 trauma patients treated from November 2006 through January 2007, showed significant increases in compliance (62% for BAC screening and 25% for BI).<br/><br/>Recommendations: One approach to reducing the number of injuries presenting to the emergency department has been to screen trauma patients for high-risk alcohol use and provide brief intervention when warranted. However, even when screening protocols are in place, staff compliance must be assessed intermittently. A lack of training in intervention and heavy workloads often prevent staff from implementing screening procedures. Reviewing patient records to determine compliance is a key step. Future plans include collaboration with psychiatry staff to review outcomes of inpatient referrals.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:14Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:14Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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