Mainstreams conversations about alcohol

1. Nursing Responses to the Full Spectrum of Alcohol Use among Hospitalized Patients Lauren Matukaitis Broyles, PhD, RN Research Health Scientist VA Pittsburgh Healthcare System Assistant Professor University of Pittsburgh School of Medicine

5. An overall change in nursing practice that: Mainstreams conversations about alcohol Promotes professional nursing Prevents alcohol-related harm for our patients and their families

6. Question 1: Regarding the package of strategies known as alcohol SBIRT(select one) • I have absolutely no idea what this is. • I’ve heard of it, but don’t know a lot about it. • I’m pretty familiar with it. • I’m very familiar with it—I’ve done it, implemented it, or, studied it. 0 of 5

8. BI Positive feedback, prevention message S 10 - 15% Hazardous Drinkers 40% Abstainers 3 - 7 % Drinkers with Abuse or Dependence 35 - 40% Low-risk Drinkers Drinkers Pyramid RT

9. Question 2: My biggest concern about bringing alcohol SBIRT into the inpatient setting is: (Select one) • How well it even fits with the acute care setting and mission • Whose responsibility it would be—who has the knowledge, skills, time, and motivation • Reimbursement • How patients would react • Something else 0 of 5

11. Question 3: My initial thoughts about nurses taking on more active roles in alcohol SBIRT in inpatient settings are: (Select all that apply) • Nurses won’t have an interest in doing it, or they are already too busy/ overwhelmed. • I’m not sure if it’s really compatible with the nursing role or scope of practice. • Inpatients won’t go for it—talking about alcohol with a nurse, or, talking about it at all. • I don’t think we can get paid for it if nurses do it. • Something else 0 of 30

12. The Proposition • Spectrum orientation • Role for every nurse • Workforce development starting with pre-licensure students • Shaping organizational context

14. BI Positive feedback, prevention message S 10 - 15% Hazardous Drinkers 40% Abstainers 3 - 7 % Drinkers with Abuse or Dependence 35 - 40% Low-risk Drinkers Drinkers Pyramid RT

15. The Proposition • Spectrum orientation • Role for every nurse • Workforce development starting with pre-licensure students • Shaping organizational context

16. Nurse and System Readiness for RN-SBIRT RN-SBIRT Training Effectiveness and Implementation Patient Acceptability for Nurse-delivered SBIRT Postdoctoral Fellowship

17. Assessing Readiness for Nurse Implementation of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT)

18. Design • Phase I: Survey of inpatient nurses • Knowledge, attitudes, and current clinical • practice around alcohol-related care • Phase II: Focus groups with med-surg • nurses • Anticipated facilitators and barriers to • inpatient SBIRT Broyles LM, et al. (2012). Addiction Science and Clinical Practice, 7:7 Broyles LM et al. (2011). Qualitative Health Research, 21(12):1705-1718

19. Implementing a Nurse Training Program for Alcohol Screening and Intervention in Inpatient Medical Settings

20. Design • Phase I: Development • Phase II: Implementation • Phase III: Evaluation of effectiveness and implementation

21. Results and Implications

22. Broyles LM, et al. (2013). Journal of Addictions Nursing, 24(1): 8-19. Broyles LM, et al. (2013). Journal of Addictions Nursing, in press

23. Patient Acceptability for Nurse-delivered Alcohol Screening, Brief Intervention, and Referral to Treatment in the Inpatient Setting

24. Results and Implications Acceptability for individual nurse-delivered SBIRT care tasks was: high (>84%) and associated with perceived ability to determine own alcohol risks, concern about use Personal discomfort with individual nurse-delivered SBIRT care tasks was: ~20% and associated with white race, age >60, positive AU DIT-C, and lower ability to reduce risk Broyles LM et al. (2012). Alcoholism: Clinical and Experimental Research, 36(4):727-731

25. Nurse and System Readiness for RN-SBIRT RN-SBIRT Training Effectiveness and Implementation Patient Acceptability for Nurse-delivered SBIRT Postdoctoral Fellowship VA Career Development Award Efficacy of Nurse-Delivered Alcohol BI for Hospitalized Veterans with Hazardous Drinking

26. Trial of Nurse-delivered Alcohol Brief Intervention for Hospitalized Veterans ClinicalTrials.gov Identifier: NCT01602172

27. 3-arm RCT • Primary outcomes at 6 months: drinks/week, binge drinking episodes, alcohol-related problems, and motivation to change drinking behavior • Sample: 320 medical-surgical patients with hazardous drinking

28. Primary Care Studies • Substance Use Care in Medical Homes • Medical Residency Training • in SBIRT • Computerized Clinical Decision Support Systems for Alcohol BI Delivery Implementation and Effectiveness of Nurse-delivered Alcohol SBIRT Across Transitions of Care Nurse and System Readiness for RN-SBIRT RN-SBIRT Training Effectiveness and Implementation Patient Acceptability for Nurse-delivered SBIRT Postdoctoral Fellowship VA Career Development Award Efficacy of Nurse-Delivered Alcohol BI for Hospitalized Veterans with Hazardous Drinking Early Independent Career

29. Lauren.Broyles@va.gov • Broyles LM, Gordon AJ. (2010). SBIRT implementation: Moving beyond the multidisciplinary rhetoric. Substance Abuse, 31(4):221-223. • Broyles LM, Rodriguez KL, Price PA, Bayliss NK, Sevick MA. (2011). Overcoming barriers to the recruitment of nurses as participants in health care research. Qualitative Health Research, 21(12):1705-1718. • Childers JW, Broyles LM, Hanusa BH, Kraemer KL, Conigliaro J, Spagnoletti C, McNeil M, Gordon AJ. (2012). Teaching the teachers: Faculty preparedness and evaluation of a retreat in Screening, Brief Intervention, and Referral to Treatment. Substance Abuse, 33(3):272-277. • Broyles LM, Rosenberger EM, Hanusa BH, Kraemer KL, Gordon AJ. (2012). Hospitalized patients’ acceptability of nurse-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT).Alcoholism: Clinical and Experimental Research, 36(4):727-731.

30. Broyles LM, Rodriguez KL, Kraemer KL, Sevick MA, Price PA, Gordon AJ. (2012). A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcoholscreening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center. Addiction Science and Clinical Practice, 7:7, open access at:http://www.ascpjournal.org/content/pdf/1940-0640-7-7.pdf. • Broyles LM, Gordon AJ, Kengor C, Kraemer KL. A tailored curriculum of alcohol screening, brief intervention, and referral to treatment (SBIRT) for nurses in inpatient settings. Journal of Addictions Nursing, in press. • Broyles LM, Gordon AJ, Rodriguez KL, Kengor C, Kraemer KL. Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment (SBIRT) for nurses in inpatient settings. Journal of Addictions Nursing, 24(1): 8-19. • Broyles LM, Conley JW, Harding JD, Gordon AJ. A scoping review of interdisciplinary collaboration in addictions education and training. Journal of Addictions Nursing, 24(1): 29-38.

31. http://www.jointcommission.org/substance_use/

32. http://hospitalsbirt.webs.com/

33. RE-AIM