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Improving Substance Abuse Screening in Adolescent Trauma Patients at a Pediatric Trauma Center
Jennifer Tabak, MSN, RN, Shefali Thaker, MPH, Garry Lapidus, PA-C, MPH, Brendan T. Campbell, MD, MPH. Pediatric Surgery and Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA.

Background: Alcohol and substance abuse (ASA) contribute significantly to the injury burden for American adolescents. ASA screening is a requirement for trauma center verification, but universal screening is difficult to achieve. The purpose of this study is to describe the implementation of a process for ASA screening by nurses that significantly improved screening rates.

Methods: Our pediatric trauma center uses the CRAFFT (Car-Relax-Alone-Forget-Family/Friends-Trouble) screen to identify patients ≥12 years of age who are at increased risk for alcohol and substance abuse. As part of our quality improvement program we routinely monitor ASA screening and referral to social work. In an effort to improve screening rates, we modified the electronic medical record to make the CRAFFT screen a mandatory field for nurses as part of their intake assessment. CRAFFT screening rates were compared between the 12 months before, and the 6 months after the intervention was implemented.

Results: From September 2014 through February 2016 our trauma center admitted 755 injured patients, and 198 were ≥12 years of age. During the 12 months before the intervention, less than half (46%, n=67) of admitted trauma patients were screened. During the 6 months after the intervention, 85% (n=45, p=<.01) were successfully screened. Overall, 11% of our pediatric trauma patients screened positive for alcohol use, and 71% of these patients were successfully referred to social work.

Conclusions: Incorporating ASA screening into the routine processes of nursing care significantly improved screening rates. Future studies will prospectively enroll patients with positive screens to evaluate the effectiveness of different focused interventions.

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