Title: Improving engagement: Implementation of motivational interviewing for inpatients with substance use disorders
Abstract:
Problem: Patients with substance use disorders (SUD) admitted to an adult inpatient psychiatric unit are expected to attend all nurse-led psychoeducational groups to engage in their recovery goals, as greater engagement while in treatment is linked to improved outcomes. However, chart review between October 2023 and January 2024 revealed they only attended 46% of groups. Root cause analysis identified a lack of standardized screening and staff training to address patient motivation for engagement.
Purpose: This quality improvement (QI) project aims to increase group attendance by adult inpatients with SUD by implementing a standardized motivational interviewing (MI) program, an evidence-based, research supported practice change.
Methods: The initiative was implemented at a large, urban, academic hospital by 41 registered nurses (RNs) over a 15-week period in Fall 2024 and impacted an average of 10 patients per week. The quality improvement project lead (QI-PL) oriented staff to the MI program at in-person mandatory staff meetings. The MI program included two structure and workflow changes. RNs admitting patients with SUD to the unit screened for motivation using a valid and reliable readiness to change (RTC) scale, and a weekly MI group was added to the schedule. A project team member completed the Motivational Interviewing Treatment Integrity tool during the MI group and gave the RN real-time feedback about their use of MI techniques. The QI-PL measured adherence to the program using three electronic REDCap tools weekly and shared regular updates with stakeholders.
Preliminary Results: In the initial training, the QI-PL oriented 92% of site staff to the MI program and 93% of RNs on the MI group topics and tools. Screening rates for RTC on admission were 0% during the first two weeks, 14% in week three, 10% in week four, and 36% in week five, with a goal of 100%. Group attendance among patients with SUD was initially recorded at 46% prior to the implementation of the intervention. Following implementation, attendance rates were 39% in week one, 40% in week two, 43% in week three, 38% in week four, and 44% in week five. The target attendance rate was set at 66%. The weekly MI group sessions were successfully completed in weeks one through four, but not during week five.
Preliminary Conclusions: Preliminary findings suggest that adopting the MI program is feasible at this site but requires continuous implementation support. Many factors may have contributed to the low initial uptake of the RTC tool. The RTC tool was not seamlessly incorporated into the electronic health record, so other reminders were necessary. Suboptimal staffing and high unit acuity during the mandatory training may have overwhelmed some staff. Psychoeducational groups are less likely to occur during these times as staff prioritize unit safety.
