| |
Patient-level
|
| |
➢ Concerns about negative patient reaction and limited patient motivation to address alcohol use
|
| |
· Patient expressions of anger, denial, dishonesty, offense, aggression, disinterest in changing
|
| | ◾ Alcohol-dependent patients |
| |
-- Challenging behavior
|
| |
-- Repeated admissions
|
| | ◾ Sex and age-related differentials between nurse and patient |
| |
Provider-level
|
| |
➢ Lack of nurse training and skills in alcohol screening, BI, and RT
|
| |
· Alcohol-related knowledge
|
| | ◾ Conceptual definitions, clinical criteria, established standards/recommendations |
| |
· Alcohol-related skills
|
| | ◾ Effective therapeutic communication techniques |
| | ◾ Goal-setting for consumption reduction |
| |
➢ Limited interdisciplinary collaboration and communication around alcohol-related care
|
| |
· Differences in prioritization and attention to alcohol issue across provider disciplines
|
| | ◾ Physician resistance/reluctance to address alcohol use or withdrawal |
| |
· Lack of effective communication with physicians, specialists
|
| |
· Lack of shared care planning with physicians, specialists
|
| |
➢ Questionable compatibility of alcohol screening, BI, and RT with the nursing role
|
| |
· Competing priorities, goals
|
| |
· Nursing advocacy and autonomy
|
| |
System-level
|
| |
➢ Inadequate alcohol assessment protocols and poor integration with the EMRc
|
| |
· Brevity of alcohol-related content in admission assessment
|
| |
· Despite admission template, lack of standardization in alcohol assessment across nurses
|
| |
· Limits of EMR regarding alcohol-related care planning
|
| | ◾ Lack of detailed patient care templates |
| | ◾ Lack of guidance on follow-up actions |
| | ◾ Inappropriately-generated automatic prompts for consults |
| |
➢ Questionable compatibility of screening, BI, and RT with the acute care paradigm
|
| | ◾ Competing priorities, goals |
| |
➢ Logistical issues
|
| |
· Lack of time
|
| | ◾ Task prioritization |
| | ◾ Uninterrupted time |
| |
· Lack of patient privacy
|
|
FACILITATORS
|
| |
Patient-level
|
| |
· N/A
|
| |
Provider-level
|
| |
➢ Improved provider knowledge, skills, communication, and collaboration
|
| |
· Alcohol and screening, BI, RT education for nurses and doctors
|
| | ◾ General knowledge, brief intervention skills, communication techniques |
| |
· Shared assessment, care planning, sense of responsibility
|
| | ◾ Inclusion of all disciplines’ professional perspectives |
| |
System-level
|
| |
➢ Enhanced EMR features for alcohol-related care
|
| |
· Electronic templates and scoring for patient screening, assessment
|
| |
· Clinical decision making algorithms/electronic reminders
|
| |
· Consultation orders linked to assessment
|
| |
· Patient education resources
|
| |
➢ Expanded processes of care and nursing roles
|
| |
· Autonomy to initiate addiction specialist consultations
|
| |
· Specialized nurse educators/specialist team focused on BI and patient education
|
