Addiction Consultation Engaging Nursing in Addiction Care
Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.
Background The Massachusetts General Hospital Strategic Initiative on Caring for Patients with Substance Use Disorder (SUD) was established in response to Community Needs Assessment identifying SUD as their number one priority.
Institute of Medicine and Robert Woods Johnson Foundation Identified key areas of focus for future education of nurses to practice to the full extent of their education and training Highlighted the reality that current and future workforce is not fully equipped to address SUD crises. Critical need for nurses specializing in SUD and addictive disorders affecting patients, families and populations.
Nurses comprise the largest segment of the health care workforce. Why is this important
3.1 million US nurses with 85% employed in health care settings Why is this important
Why is this important Nurses often provide the first point of contact and most sustained contact with patients and families throughout the trajectory of hospitalization
Setting 1057 bed urban academic medical center 48,587 annual admissions >100,000 emergency department visits annually ED sees >9,000 substance use disorder (SUD) patients annually 1,989 admitted SUD patients MGH staff includes more than 4,300 registered nurses
From ER to Inpatient Emerging trends of SUD have serious implications for nursing practice Patients with alcohol and other substance use disorders (SUD) presenting for care have complex conditions that require intense nursing care. Patients often have tri-morbidity with medical, psychiatric, and psycho-social needs. Day to day care of patients in an acute care setting is primarily tended to by nurses.
MGH Professional Learning Environment Nursing survey identified education R/T treatment of patients with SUD as a top priority Nursing Survey
63% of staff RN s felt not prepared or only somewhat prepared to respond to needs of patients with SUD. Nursing Survey
56% of MGH nurses are not prepared or only somewhat prepared to manage Compassion Fatigue (CF) directly linked to caring for patients with SUD Nursing Survey
Nurses The SUD initiative established an Education Committee, which is co-chaired by Advanced Practice Nurse, Psychiatrist and a Physician SUD initiative established Nurse Team Leader for inpatient Addictions Consult Team (ACT) Nursing Director, Education co-chair APRN and ACT NP team leader all invited to be active participants of the SUD Executive Implementation Group.
Initial Nursing Assessment Implemented on every patient at the time of admission to MGH and used to assess and document every patient s medical, psycho/social history and daily level of functioning, to assist in the identification of critical needs, now includes general screening questions regarding SUD.
Assessment on Admission Effective November 4, 2014, Screening for Alcohol Use and Substance Use hospital wide was established at the MGH Initial Nursing Assessment (INA) of all admitted patients asks two sets of questions that could identify a patient with at risk substance use behaviors.
Single Question Screener The question below (validated by the National Institute on Drug Abuse) will be used to assess for illicit use of substances other than alcohol and nicotine:
What if the answer is Yes? If patient answers Yes, the screening nurse will: Ask for more information about what type of substance and how much they use. Inform and consult with responding/admitting clinician about the patient s positive response Assess patient for symptoms of withdrawal Assess for patient readiness for education about associated health risks Consider need for additional resources/consults
Alcohol Use Disorder Alcohol screening has been identified as the 3 rd highest prevention priority for US adults by the US Prevention Services Task Force Linking health issues that are related to alcohol use can help engage patients in changing their drinking habits Positive feedback on the benefits of any decrease in drinking can help motivate some patients to change Nurses are uniquely positioned and skilled to have this conversation with patients
Overview of AUDIT-C The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) administered to every patient at the time of admission. AUDIT-C Is a validated three question screening tool assessing the level and pattern of alcohol consumption Identifies patients at risk for hazardous or unhealthy drinking or an active alcohol use disorder
AUDIT-C
Knowledge Deficit Identified Nurse training for screening SUD was followed by questionnaire that identified- 50 % of nurses were not sure what to do once they screened the patient 25 % were not sure how to communicate the results of screening tool to patients 25 % were not comfortable with SUD subject matter
Nursing Nursing leaders from the MGH Knight Center, the MGH Munn Center and Addiction nurse specialists from the ER, ACT, and Psychiatric services are in process of preparing a curriculum to address identified learning gaps. A cohort of nurses will be recruited to participate in an intensive training opportunity That will culminate in them sitting for Certified Addictions Registered Nurse Exam (CARN) or (CARN AP).