Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance use?
Tran D.T., Stone A.M., Fernandez R.S. et al. Contemporary Nurse: 2009, 33(1), p. 13–19.

Hospital nurses in Sydney in Australia were trained to implement a new screening and intervention policy aiming to upgrade the identification of hazardous drinkers and other substance users among medical and surgical inpatients. Disappointing results highlight the need to do more than inform and exhort if practice is to change.

Summary
To improve nurses' screening of patients for substance use problems during routine admission procedures, a large metropolitan health service in Sydney in Australia developed a clinical guideline titled Substance Use Screen Policy which was distributed to all its facilities and implemented through an in-service education programme. Half-day workshops covered topics such as managing withdrawal, intoxication and overdose. Training in brief interventions included 'safe' levels of smoking or drinking, smoking cessation techniques, illicit drug use, access to needle exchange programmes, and patient education pamphlets. Nurses who could not attend were given education packages with workshop handouts. The featured study investigated the effectiveness of this dissemination effort.

Data for the study was derived from medical record audits conducted in selected medical and surgical wards of two metropolitan hospitals prior to and three months following implementation of the guideline. According to the new policy, records for newly admitted patients should document whether they had been asked about smoking, drinking and drug use, their substance use, withdrawal symptoms, any related treatment given, and whether any further actions or plans had been agreed. A preliminary audit found that only 20% of admission records had complete substance use histories. Implementation of the guideline was expected to raise this to 50%.