Lacey Whitlatch
Frontier Nursing University
Lacey is Family Nurse Practitioner providing primary care in a rural Federally Qualified Community Behavioral Health Center in Athens, Ohio. She received her Masters of Science in Nursing at Frontier Nursing University in June of 2016 and conferred her Doctor of Nursing Practice Degree at Frontier Nursing University on March 28th, 2017. Previously, Lacey worked as a Registered Nurse in varying health care arenas including; Emergency Department, ICU, Post-Op Organ Transplant, Med/Surgical, and Cardiology. Lacey looks forward to a life-long journey of clinical scholarship in the practice setting.
BACKGROUND: Screening, Brief Intervention, Referral to Treatment (SBIRT) service documentation was inadequate because of a poorly defined workflow that captures SBIRT services documented in the electronic health record (EHR). ... [ view full abstract ]
BACKGROUND: Screening, Brief Intervention, Referral to Treatment (SBIRT) service documentation was inadequate because of a poorly defined workflow that captures SBIRT services documented in the electronic health record (EHR). The aim of this study was to increase the timeliness and effectiveness of SBIRT services through implementation of universal, well validated, screening tools for alcohol, drugs, and depression. The study was set in a rural primary care clinic in Southeastern Ohio. Participants include a family nurse practitioner, licensed practical nurses, a behavioral health consultant (BHC), a front desk specialist, and an electronic health record specialist.
METHODS: The Plan Do Study Act (PDSA) methods of quality improvement were used for this project. Baseline assessment included chart reviews of patients’ EHR’s 4-6 months before project initiation. Documentation of pre-screens and full screens for alcohol use, drug use, and depression were reviewed. The performance of a brief intervention (B.I.) for full screen positives, BHC utilization, referral to treatment, and usage of SBIRT specific code were also collected.
INTERVENTION: The Substance Abuse and Mental Health Service Administration (SAMHSA) and Health Resources and Services Administration (HRSA) SBIRT toolkit was selected to guide implementation. The implementation team adopted a “we ask everyone” culture and provided data transparency on performance throughout implementation. A drug full screen was incorporated into the EHR. Additionally, SBIRT specific EHR templates were used.
RESULTS: Median scores for depression full screen completions increased by 50%. Median scores for B.I.’s performed increased from 25% to 60%. Behavioral Health Consultant utilization decreased from a 40% median to a 33% median and SBIRT services captured increased to 65%.
CONCLUSIONS: The SAMHSA-HRSA toolkit, data transparency, team engagement, and EHR integration were key factors for increasing timely and effective SBIRT services. Employing PDSA quality improvement cycles within the day to day clinic workflow, presents measurable benefits.
Organizational factors (such as structure and culture) that drive overuse
