Alcohol Abuse Screening for the Injured Patient

 

VBMC TRAUMA CARE SERVICES GUIDELINE

TITLE: Alcohol Abuse Screening for the Injured Patient

GUIDELINE:

The purpose of this policy is to identify those patients with the need for alcohol abuse evaluation and counseling, as well as to ensure access to appropriate substance abuse treatment resources in the community. Alcohol abuse/misuse is a proven contributing factor to trauma. Risk levels of alcohol abuse can be measured by using evidence-based screening tools. SAMHSA (Substance Abuse and Mental Health Services Administration), NIH (National Institute of Health), and American College of Surgeons Committee on Trauma all advocate and recommend the implementation of Screening, Brief Intervention & Referral to Treatment (SBIRT) as a validated method for addressing alcohol misuse in patient populations. Utilizing the teachable moment after injury to intervene in patients with alcohol abuse serves as an effective strategy for future injury prevention.

An alcohol misuse screening should be completed for all injured patients admitted to VBMC. Health care providers, family members, and/or the patient can request available outpatient substance abuse treatment resources at any time. The Trauma Staff, including attending physicians, resident physicians, advanced level practitioners, nursing, and other members of the multidisciplinary team providing care to the patient can identify patients with clinical features of alcohol abuse. A validated alcohol misuse screen shall be asked of every patient on admission. The validated screening tools for alcohol abuse used on patients 17 years and older will be either the Alcohol Use Disorder Identification Tool (AUDIT) or the Alcohol Use Disorder Identification Tool – C (AUDIT-C). Injured patients, age 13-16 years old meeting criteria will have an SBIRT with CRAFFT completed. A positive screen is also deemed by a positive blood alcohol level on admission or self-report of alcohol abuse on admission history.

A positive screen for injured patients is defined by any of the following screens:

  • positive blood alcohol result > 0
  • AUDIT-C score of > 4 for men and > 3 for women
  • Self-report alcohol abuse on admission history
  • AUDIT score of > 8

 

Injured patients screening positive will receive intervention/ counseling with referral to treatment if the patient is alert and cognitively able to understand and communicate. The brief intervention provided will consist of evidence- based motivational interviewing techniques utilizing the Feedback, Listen & Options (FLO) model.

If indicated, a variety of treatment options are offered and advocated. However, the patient has the option to refuse treatment. The patient also has the right to refuse SBIRT altogether.

For patients meeting high risk criteria, a referral to treatment packet will be provided that includes available community resources: Alcohol Anonymous locations & times, counseling services, support groups, as well as several inpatient & outpatient voluntary treatment options within the South Carolina.

Compliance will be measured monthly. Screening/Intervention Exclusion Criteria: patient discharge within 24 of admission, patient refusal, un-resolving cognitive impairment with patient inability to understand or unimproved decreased level of consciousness or any other medical barrier that prevents communication on the required level for SBIRT.

 


RESOURCES/REFERENCES:

American College of Surgeons Committee on Trauma. Alcohol Screening and Brief
Intervention (SBI) for Trauma Patients: COT Quick Guide. Retrieved from https://www.facs.org/~/media/files/quality%20programs/trauma/publications/sbirtguide.ashx

Babor, T.F.. & Higgins-Biddle, J.C. (2001). Brief Intervention: For Hazardous and Harmful Drinking A Manual for Use in Primary Care. World Health Organization.

Committee on Substance Abuse (2010). Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics, 125 (5), 1078-1087. doi: 10.1542/peds.2010-0438

Higgins-Biddle, J., Hungerford, D., & Cates-Wessel, K. (2009). Screening and Brief Interventions (SBI) for Unhealthy Alcohol Use: A Step-By-Step Implementation Guide for Trauma Centers. Atlanta
(GA): Centers for Disease Control and Prevention.

Mitchell, A.M., Hagle, H., Puskar, K., Kane, I., Lindsay, D., Alcott, K., ... Goplerud, E. (2015). Alcohol and Other Drug Use Screenings by Nurse Practitioners: Clinical Issues and Costs. The Journal for Nurse Practitioners, 11 (3), 347-351.