University of Pittsburgh, USA.
Irene Kane is an Associate Professor of Nursing with extensive clinical, teaching and research experience in developing and teaching health promotion programs emphasizing disease prevention and health management to improve psychobiological wellbeing. She is a certifi ed Screening Brief Intervention and Referral to Treatment (SBIRT) trainer with over 25 papers published in peer-reviewed journals and share SBIRT training knowledge, skills and outcomes to address substance use identifi cation and brief interventions earlier along the continuum of use, misuse, abuse and dependence.
Background: Substance use is an international public-health priority with 2.5 million deaths from the harmful use of alcohol reported annually (World Health Organization (WHO) 2011 Global Status Report). Further, at least 15.3 million persons have drug use disorders (WHO, 2014). Risks with use of alcohol and other drugs are connected with 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) in four diverse hospital settings to utilize an evidence-based practice (Screening, Brief Intervention and Referral to Treatment: SBIRT). Screening individuals for substance misuse presents opportunity for timely brief interventions to enhance motivation to reduce use or suggest further referral options. Training and curriculum infusion of SBIRT face-to-face sessions, online course review, one-on-one booster guidance, and nurse champion development into EDRN professional continuing education practice required individualized planning and coordination with multiple management level support, buy-in from ED nurses, and flexible training schedules.
Methods: The University of Pittsburgh School of Nursing partnered with a community non-profit organization, the Institute for Research, Education and Training in Addictions (IRETA), and the University of Pittsburgh Medical Center (UPMC) to educate ED nurses in the skills necessary to address substance misuse to improve the quality of care through SBIRT. This interprofessional (academic-community-health provider) partnership trained ED staff in four hospitals located in urban, rural, and low-income communities. SBIRT training implementation required: 1) collaboration and planning with all levels of management; 2) appointment of a nurse champion to support on-site education and ensure ongoing SBIRT competency; 3) detailed discussion of training components and scheduling with ED nurse manager and champion; and 4) implementation of EDRN training with evaluation and consultative return visits by trainers.
Results: Multi-level management coordination and engagement of EDRNs with ensuring flexible SBIRT educational opportunities and timelines ensured successful EDRN training outcomes. Overall, 134 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.