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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3010 — Anticipated Barriers and Facilitators Associated with Nurse-Delivered Alcohol SBIRT for Hospitalized Veterans

Broyles LM (Center for Health Equity Research & Promotion (CHERP) & VISN 4 MIRECC; VA Pittsburgh Healthcare System, VAPHS), Rodriguez KL (Center for Health Equity Research & Promotion & Geriatric Research, Education, and Clinical Center (GRECC); VAPHS), Kraemer KL (Center for Research on Health Care, University of Pittsburgh), Gordon AG (Center for Health Equity Research & Promotion and VISN 4 MIRECC; VAPHS)

Objectives:
The VA has implemented alcohol screening, brief intervention, and referral to treatment (SBIRT) in primary care settings to improve identification and management of alcohol misuse. SBIRT may be similarly effective in the inpatient setting, and the Joint Commission is pilot-testing accreditation measures which would require alcohol SBIRT for all hospitalized patients. However, factors which might impact SBIRT implementation in inpatient settings, particularly if delivered by nurses, are unknown. The purpose of this study was to identify anticipated barriers and facilitators associated with nurse-delivered SBIRT for hospitalized Veterans with alcohol misuse.

Methods:
We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large Veterans Affairs Medical Center. Transcripts were analyzed using the grounded theory technique of constant comparison to identify key themes and concepts regarding anticipated barriers and facilitators at the patient, provider, and system levels.

Results:
A total of 33 medical-surgical nurses (97% female, 79% white) participated in seven focus groups. Participants consistently anticipated the following barriers to nurse-delivered SBIRT for hospitalized Veterans: 1) lack of nurse training and skills in SBIRT; 2) limited interdisciplinary collaboration and communication around alcohol-related care; 3) inadequate alcohol assessment protocols and poor integration with the electronic medical record (EMR); 4) concerns about negative patient reaction and limited patient motivation to address alcohol use; and 5) questionable compatibility of SBIRT with the acute care paradigm and nursing role. Suggested facilitators of nurse-delivered SBIRT focused on provider- and system-level factors related to: 1) improved provider knowledge, skills, communication, and collaboration; 2) expanded processes of care and nursing roles; and 3) enhanced EMR features.

Implications:
Implementation of nurse-delivered SBIRT for hospitalized Veterans would require overcoming patient-, provider-, and system-level barriers. The majority of suggested facilitators for SBIRT delivery could be feasibly designed and put into practice. More comprehensive and strategic approaches may be needed to address barriers related to clinical collaboration and the acute care culture and setting.

Impacts:
Early consideration of such perceived barriers and facilitators will facilitate the design and testing of alcohol SBIRT interventions for hospitalized Veterans and help position the VA for responding to potential hospital accreditation measures.


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