Table 1 Capability-Related Barriers
BCW Source | Agent | Barrier/Facilitator | Quote | Intervention Function and Proposed Intervention |
|---|---|---|---|---|
Capability (Psychological) [Barrier] | MD/NP/ RN | ED staff are unaware that NTX can be used to treat AUD. | “I just don’t think that a lot of us feel very comfortable with it because we don’t really have a lot of training in it. It’s not something covered in medical school and it’s not something that we currently do in the emergency department.” -Resident | Education: Lecture for residents during Grand Rounds. Presentation for faculty at faculty meeting. |
Education: Creation of posters describing NTX and treatment algorithm. | ||||
Education: Presentation for nurses during morning huddles. | ||||
Education: Establish champions among MDs and RNs that staff can approach with questions. | ||||
Enablement: Creation of AUD & AWS order set that includes educational material about indications, dosing, side effects, and contraindications. | ||||
Enablement: Creation of AUD & AWS guidelines. | ||||
Capability (Psychological) [Barrier] | MD/NP/ RN/CSW | ED staff unfamiliar with screening tools to identify AUD. | “Well, I think alcohol use disorder population is actually kind of a broad-- it’s a broad spectrum of disease. I think alcohol use disorder hits all groups, all populations. So there isn’t one specific population that will have it... It’s like, it’s really hard to have a uniform approach to it” -Attending | Training: Train providers on the use of AUDIT-C assessment. |
-“Are there specific scales or questionnaires used to diagnose alcohol use disorder in the emergency department?” -“I feel like that’s relatively limited in the emergency department. I think oftentimes we either catch on either their presenting complaints in one facet or another, as we just discussed, or the residents uncover it as part of the review of systems.”-Attending | Training: Create a script that staff can use when asking patients about their alcohol use. | |||
Capability (Psychological) [Barrier] | MD/NP/ RN/CSW | ED staff find it difficult to identify a patient’s stage of change. | “Again, you have to admit it’s a gray area. They’re not either, ‘Oh, they’re ready now.’ Versus, ‘They’re not ready.’ There may be that gray area, that’s where I think you’re truly speaking to your patient and how to figure out--would he be receptive to it? -Attending | Training: Train staff in motivational interviewing to better identify patient’s stage of change. |