Toolkit

Screening

Audit

 

The Alcohol Use Disorders Identification Test (AUDIT) is an instrument adapted from the World Health Organization. Validation studies have been carried out in the United States and other countries. The drinking limits have been adjusted to fit the US guidelines for average drinking. The first three questions are quantity and frequency questions. The next three questions (4-6) ask about possible alcohol dependence. These questions are important because possibly dependent patients receive a more intensive intervention. The final four questions (7-10) ask about a series of alcohol-related problems that patients may have experienced.

 

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DAST

 

The Drug Use Questionnaire or DAST-10 is a medical screening tool/aide to help you document the patient's drug abuse (prescribed, over-the-counter, non-medicinal) history over the past 12 months, excluding alcohol and tobacco. The summative score assigned at the end of the questionnaire will assist you in determining the patient's At-Risk score/zone.

 

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Single Alcohol Screening Question (SASQ)

 

The prescreening instrument is a simple single question developed by the National Institute for Alcohol Abuse and Alcoholism (NIAAA) called the Single Alcohol Screening Question (SASQ). During the prescreen process, the patient will be asked to refer to a chart of standard drink sizes and then asked, "How many times in the past 12 months have you had X or more drinks in a day?" where X is 5 for men and 4 for women. A positive screen, where the patient replies that this has happened one or more times in the past year, will trigger the need for further assessment and an intervention to be done by the clinician. Exceeding daily limits constitutes a binge.

 

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Standard Drink Chart & Drink Conversion Chart

 

It is important to define the quantity in a standard drink. We need to understand this among ourselves and as we talk with patients. We encourage all clinic personnel to use charts like this to refer to during discussions with patients about their drinking.

A standard drink is one 12-ounce can of beer, 8-9 ounces of malt liquor, a 5-ounce glass of wine, or a single shot of spirits (that's about an ounce and a half). The chart also gives specifics how many standard drinks are in larger containers in which alcohol is frequently sold or served.

 

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Opioid Risk Tool

 

The Opioid Risk Tool is a short instrument that assesses for potential risk of opioid misuse based on personal history of alcohol or substance use/misuse, family history of alcohol or substance misuse/abuse, as well as some other factors. It generates a score to help determine the level of risk patient may have related to opioid misuse or abuse which may then determine the physician's level of monitoring over the course of treatment with opioids.

 

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Intervention

Alcohol & Drug Intervention Card

 

The SECSAT Alcohol & Drug Intervention Card was developed to use as a guide and outline for a brief alcohol intervention with patients. One side includes a standard drink chart, low-risk alcohol consumption chart and a diagram to use as a visual aid to demonstrate level of risk based on the patient's AUDIT score. The other side includes an outline of an MI- based brief alcohol intervention, as well as including a menu of options for patients at higher levels of risk who may need additional forms of treatment.

 

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Blue Brochure (Zone I)

 

The Blue Brochure is for patients scoring in Zone I with at-risk patterns of alcohol use and follows the same outline as the intervention card. It also includes additional information regarding drinking triggers and ways to cope with trigger situations which may be helpful for patients to consider if trying to cut back or quit. This brochure may also be used as patient education and given to the patient to take home as an encouragement to follow through on any decisions made regarding reducing his/her drinking, or to prompt further thought about the possibility of making a change.

 

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Red Brochure (Zone II)

 

The Red Brochure is for patients scoring in Zone II who may be possibly dependent on alcohol and/or have suffered major consequences as a result of their alcohol use. This brochure follows the brief intervention outlined on the intervention card with the additional steps of assessing withdrawal risk and consideration of higher levels of care for those patients interested and/or in need of it.

 

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Green Brochure (Follow-Up)

 

The Green Brochure is intended for use as a follow-up intervention for patients with whom alcohol use has been discussed in previous appointments. It reviews the MI-based brief intervention, as well as includes a 7-day drinking diary to assess for change in alcohol consumption patterns from previous visits.

 

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Opioid Intervention Card

 

The SECSAT Opioid Intervention Card was developed to use as a guide and outline for assessment, including prescription drug misuse risk assessment, a monitoring framework for assessing risk versus benefit, as well as how to manage concerning patient behaviors related to their opioid use and finally discontinuing opioids if deemed necessary. The opioid intervention card was designed to fit the SBIRT model where risks assessment meets the screening aspect, the monitoring framework emphasizing universal precautions fits the brief intervention component and finally referral to treatment is included as with alcohol and illicit drug misuse/abuse.

 

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Sample Pain Assessment Note

 

The SECSAT sample pain assessment note is an instrument utilizing the 6 As of assessment including Analgesia, Affect, Activity, Adjuncts, Adverse effects, and Aberrant behaviors. The first three items comprise a standardized scoring instrument determining benefit called the PEG which stands for Pain, Enjoyment of Life, and General Activity which correspond with the first three As. Documenting a PEG score at each visit helps determine benefit over time. The backside of this note is adapted from the Pain Assessment & Documentation Tool (PADT) and helps to document concerning or aberrant behaviors from visit to visit to also aid in assessing risk versus benefit over time.

 

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Sample Controlled Substances Agreement

 

The SECSAT sample controlled substances agreement includes each of the universal precautions outlined in Module 2 of the pain and addiction series. It is used to work collaboratively with the patient to develop an understanding of the monitoring framework within which the physician and patient are expected to abide to provide for the patient's greatest benefit and to minimize potential risks.

 

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Resources

Alcohol Fast Facts

 

What is the evidence base for performing brief interventions and how effective are they? This document quickly covers the rationale for performing screening and intervention, as well as stresses the importance of training and total systems/personnel involvement and provides a reference list supporting each point.

 

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Marijuana Fast Facts

 

This document quickly covers the rationale for performing screening and intervention as it pertains to patients with regular use of marijuana. Additionally, it stresses the importance of pertinent positives and negatives the clinician should be aware while screening. A reference list supporting the point made is also included.

 

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Marijuana Role Play Scripts

 

Role play scripts for patients with at-risk and high risk marijuana use.

 

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DAST for Marijuana Role Plays

 

DAST instrument completed for at-risk and high risk marijuana use for role play purposes.

 

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Opioid Module 1 Role Play Scripts

 

Role play scripts for the assessment portion of the encounter for a patient requesting/requiring an opioid prescription for pain.

 

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Opioid Module 2 Role Play Scripts

 

Role play scripts for the agreement and universal precautions portion of the encounter for a patient requesting/requiring an opioid prescription for pain.

 

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Opioid Module 3 Role Play Scripts

 

Role play scripts for a patient scenario in which the patient is demonstrating some concerning medication-taking behaviors related to his/her opioid prescription.

 

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Implementation Guide

 

Description Coming Soon.

 

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