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Table 5 Anticipated facilitators to implementation of nurse-delivered screening, brief intervention, and referral to treatment

From: A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center

Suggested facilitators Supplementary examples of quotationsa
1. Improved provider knowledge, skills, communication, and collaboration “[We need] education on different communication techniques…resources we can teach patients about, and referral to treatment.”
  “. . . we could actually have someone give us a sheet that says something like “Here are some little pointers or tips on how to address these issues with your patient” because, like I said, I’ve been here my whole entire nursing career and not once have I ever had anybody tell me (that type of information).”
  “I think it should be nurses and doctors together. . . Both of our responsibilities- the whole idea of having two eyes see the same thing. We’re both asking them questions about alcohol, but yet nothing still is being done about [the patient’s alcohol use].”
  “if it’s all in [a shared] care plan, maybe it would be easier to address it and fit it in. . . when you’re going in to take care of the patient, you know, “Oh, I see you spoke to [the addiction specialists]-- how’s that going for you?”
  “. . .it’s advocating more for the patient . . more collaborative treatments with the physicians and being proactive about alcohol in our setting.”
2. Enhanced EMRb features Nurse 1: Maybe [the EMR] could just pop up whenever you’re doing the assessment and just put the (addiction) consult in.
  Nurse 2: Yeah, ‘cause I like that idea, that triangle (drinkers pyramid) diagram that you keep showing. On admission assessment, like-
  Nurse 3: Maybe if a patient falls in this section-
  Nurse 2: Yeah, falls in the top two tiers they need a consult and would it automatically pop up.
  “Something in the EMR like [the online patient education company]. I like it because you can give it to the patient, you give them the option, ““Would you like me to stay in here and discuss this with you, or would you like to have this and read over it?”
3. Expanded processes of care and nursing roles Nurse 1: “I think [brief intervention] would be more effective if the patient had someone to be accountable to after discharge, also. ‘Cause they’re going to forget about us in three days but if they have that one steady person I think they’d be more likely to follow through.
  Nurse 2: Yeah, if you had, like, one special team that went around and did that,
  I think that’d be more beneficial.
  “[A facilitator would be] being able to make our own consults – put in our own consults – because maybe it’s being overlooked by someone else and we made a nursing decision thinking that based on what the patient’s telling us we can make our own consult to the [addiction consultation-liaison] team. Or we contact them directly . . . to advocate for that patient if we felt that they needed it.”
  “I think “the readiness ruler” (shown in video) is a very good tool that someone could use if we had maybe educators that came to the floor to take care of the patient, educate them one-on-one, like the diabetic educator that comes to the units.”
  1. a Quotations extracted from transcripts of 7 focus groups with 33 nurses from 3 medical-surgical units.
  2. b EMR = Electronic medical record.