Doctor of Nursing Practice
Joan O’Rourke, DNP, MBA, RN
Susmita Adhikari, FNP
To address substance abuse multiple organizations recommend increase drug abuse screening as part of routine health care. CAGE AID is five-question tool used to screen for drug and alcohol use, answering yes to two or more questions indicates further assessment is advised. Unfortunately, most primary care centers do not use screen for substance abuse using validated instrument tools such as the CAGE-AID tool.
The purpose of this evidence-based practice (EBP) project is to implement the CAGE-AID Substance abuse screening tool by nurse practitioners students in a family clinic located in Bridgeport in order to increase to number of referrals to primary provider or further evaluation.
The institute of healthcare improvement (IHI) model for improvement and the EBP model was utilized to guide the implementation of this project in family clinic located in Bridgeport, where screening was not the current practice. The project manager educated two advance licensed practitioners students (ALPS) who were doing their clinical hours at the family clinic (one nurse practitioner student and one physician assistant student). The goals, of the education was to show them how to use the CAGE-AID substance abuse screening tool. The two ALPS were assigned to screen 200 adult patients presenting to clinic for any complaints using the CAGE aid tool before primary care provider (MD/NP/PA) had a face-face encounter. The screeners recorded the number of patients screened per week and the number of patients referred to the primary provider for further assessment. Data was scheduled to be collected over 8 weeks. The Outcomes were measured after the implementation of screening with the number of positive screens referred to the primary care provider for further testing.
The project manager did not achieve full project implementation due to loss of buy-in from key stakeholders due to the covid 19 pandemic. From the total 200 planned patients to be screened, only 18 were screened over a period of two weeks. Out of the 18 patients, only two patients screened positive for substance abuse. One of the patients had a previous history of substance abuse but another referral was made. The other patient was referred to the primary doctor for further assessment. Other limitations included resistance to change, and inability to return to the clinic to continue implementing the project.
Full implementation was not achieved, from 18 patients screened, two were referred (11%) for possible substance abuse and brought to the attention of the primary care provider for further assessment. There was no data before implementing the QI project regarding the number of screened patients for substance abuse, so this was a new change in practice.
There was a 11% increased referral for further assessment compared to no recorded data prior implementation. But considering the small sample limitation and incomplete implementation of this project, this writer recommends further studies/testing to corroborate that increasing substance abuse screening can increase patient referrals to primary provider for further evaluation. This project did not lead to a change of practice protocol in regard of substance abuse screening at the family clinic.
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Milla, C. (2022). Increasing opioid abuse screening in primary care clinic: An evidence-based quality improvement project. [Unpublished DNP project]. Sacred Heart University.