Recommended Best Practices of Emergency Medical Care for the Alcohol-Impaired Patient

The following Best Practices are intended to serve as the basis for changing how patients with alcohol use problems are treated in the ambulance, the emergency department (ED), and the trauma center.

Recommended Best Practices for Nurses

1. Listen to pre-hospital professionals’ report, and elicit patient information indicative of alcohol use problems.

Pre-hospital professionals often have information related to the patient’s circumstances and surroundings that can be key in identifying an alcohol use problem. Listening for this information and eliciting this information from pre-hospital professionals is an important and necessary method of completing a patient assessment.

2. Identify alcohol-related events in initial assessment of the patient.

The nurse should use all five senses during the initial assessment and ask the patient/family/caregiver/ emergency medical services professionals direct questions to identify alcohol-related visits to the ED.

3. Perform an assessment using appropriate tools, such as history, physical examination, and screening tools.

Patients with alcohol use problems often have specific physical attributes and can develop specific chronic health problems related to their alcohol use problems. Assessment should include conducting a physical examination, history-taking, and looking for the presence of these signs, symptoms, and chronic physical problems. Assessment also should include the use of a screening tool to identify patients with alcohol use problems that may not be readily apparent or to assess the extent of the alcohol use problem. With multiple other checklists to perform and numerous other patient groups to care for, group also discussed potential reluctance of some emergency nurses to do "one more thing." Strategies for implementation of assessment tools will have to address this potential barrier.

4. Document objective findings of assessment, interventions, and plan of care for patient with alcohol use problems.

All findings of physical exam, history taking, and screening should be documented, as well as any interventions that are implemented and the plan of care for the patient with an alcohol use problem. This documentation will serve as a reference for those rendering care to the patient, once they are transferred or discharged from the ED.

5. Collaborate with health care team to implement interventions, such as brief interventions, discharge planning, and referral.

All aspects of care related to the patient with an alcohol use problem, such as the use of screening tools, the use of brief interventions, discharge planning, and referral for treatment, should be part of an standardized approach, agreed to by all members of the health care team.

6. Communicate plan of care to appropriate services, such as physicians, substance abuse counselors, referral agencies, and inpatient caregivers.

By definition, emergency care is brief, episodic, and crisis-oriented. The alcohol use problem and its treatment will not be a resolved issue by the time treatment is completed in the ED. Therefore, it is imperative to communicate the plan of care for the alcohol use problem to all members of the health care team that will care for the patient upon discharge or transfer. The goals are a seamless continuum of care of the alcohol use problem and the patient with an alcohol use problem.

7. Provide care for the alcohol-impaired patient(s) in a professional and nonjudgmental manner.

It is absolutely inappropriate for the health care professional to treat the patient with an alcohol use problem in any way that might be considered judgmental or unprofessional.

8. Advocate in the community for public education, prevention programs, public policy, and treatment programs for alcohol use problems.

Since hospital policy and public policy both have a direct effect on the nurse, in the nurse’s ability to render comprehensive care to the patient with an alcohol use problem, and to find the resources to meet the needs of the patient with an alcohol use problem, it behooves the nurse to become actively involved in the hospital and in their community, to advocate for public education, prevention programs, public policy, and treatment programs for patients with alcohol use problems.

9. Participate in collaborative research, education and data gathering to improve the care of patients with alcohol use problems.

As with any other form of health care, research is necessary to ensure maintenance of the "state of the art." Nurses should conduct and participate in research to improve identification and care of the patient with an alcohol use problem.

10. Integrate alcohol screening and alcohol education into curricula, continuing education, and standards for emergency health care professionals.

The knowledge base of health care professionals must be elevated, to include more information on alcohol use problems. Alcohol screening and education regarding comprehensive care of the patient with an alcohol use problem should be included in the curricula of nursing schools, medical schools, residency training, emergency medical services training, continuing education for practicing nurses, emergency physicians, trauma surgeons, and pre-hospital professionals; and should be an established and documented standard of nursing care, medical care, and pre-hospital care of the patient with an alcohol use problem.

Source: National Highway Traffic Safety Administration. Developing Best Practices of Emergency Care for the Alcohol-Impaired Patient: Recommendations from the National Conference. Washington, DC; 2001.