Nurse-led screening, brief intervention, and referral to treatment for patients with alcohol use disorder in an inpatient setting

Abstract

Many preventable health risks result from unhealthy alcohol use. Two hundred thirty International Classification of Diseases (ICD-10) diagnosis codes are partially or completely associated with alcohol use disorder. The prevalence of alcohol use disorder (AUD) has risen in tandem with the COVID-19 pandemic. This creates an urgent call to action for clinicians to help patients recognize risky alcohol use and decrease the devastating burden this disease causes the individual and society. Healthcare providers generally receive limited content on how to address alcohol abuse in their training, and nurses generally lack confidence in addressing patients with AUD. Screening, brief intervention, and referral to treatment (SBIRT) is an effective, evidence-based process to identify and mitigate risky substance use. The screening portion of the SBIRT process involves the utilization of an Alcohol Use Disorder Identification Test (AUDIT-C) to stratify a patient's drinking into zones of risk. The purpose of this project was to utilize the literature to develop an educational training for nurses on the use of the AUDIT-C tool and motivational interviewing techniques to assist them in the SBIRT process. The project was implemented over a 6-week period on a 29-bed medical oncology unit within a 150-bed hospital in Western Montana. Forty-five nurses were administered a Likert scale survey at baseline and after watching the SBIRT educational PowerPoint to assess their confidence in addressing patients with AUD. The primary goal of this project was to increase nurses' self-reported levels of confidence in performing SBIRT care tasks. A secondary goal was to increase the frequency of AUDIT-C and SBIRT tool documentation within the electronic medical record (EMR). Outcomes of the project demonstrated that 70% (n=28) of survey respondents either agree or strongly agree they have confidence to carry out SBIRT-related care tasks after the SBIRT educational training as compared to 12.6% (n=2) at baseline. The project did not increase the frequency of AUDIT-C and SBIRT documentation within the EMR. These results are consistent with results in the literature, which suggest that, with adequate training, nurses in inpatient settings can play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.