BARRIERS | |
---|---|
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 |