It is widely known that opioid abuse and overdose deaths have been problematic. In fact, opioid abuse is largely referred to as an epidemic. Tragically, seventy percent of the US drug overdose cases involved some sort of opioid. The American Nurses Association (ANA) has noted that, in part, the current US crisis has been created by ineffective medical efforts to manage chronic pain.
On the other hand, opioids can provide highly effective pain management for acute pain that originates from injury, surgery, cancer, and palliative or end-of-life-care. Appropriate prescribing helps manage pain and helps reduce patient abuse. Fortunately, the data indicates US healthcare providers are making headway. Since 2012, prescription overdose deaths have been declining. There were 67,367 US drug overdose deaths in 2018, which represented a 4.1% decline from 2017. Nurses have been instrumental in turning this around.
Frontline nurses have contributed to patient safety and effective pain management in primary care. Their work extends beyond primary care in assorted direct patient care and leadership roles. As skilled educators and patient advocates, nurses can help patients and families understand opioid treatment choices as well as introduce other pain management modalities such as physical therapy, psychological management options, complementary medicine and non-opioid management strategies to ease the burden of pain.
- Further Training and Education
Nurses who are involved with pain management treatments should expand their education by attending conferences, searching for the latest evidence-based practices, and taking additional coursework (CEUs) to increase their knowledge on opioid prescription best practices. Such a quest for new knowledge should include an interdisciplinary focus that includes mental health, behavioral health, and complementary or alternative pain management approaches.
- Stay Current on Regulations
As of 2017, all 50 states in the US have developed Prescription Drug Monitoring Programs (PDMPs). Access to PDMPs may determine if the patient has a history of using multiple doctors, frequent ER visits, or demonstrates other evidence of prior drug abuse such as frequent opioid prescriptions. The PDMP also records primary care provider prescription activity. It is the provider’s responsibility to know of all state regulations and required reporting.
- Assess Patient Risk Levels
Nurses can obtain a thorough patient history. The practitioner should verify injury by the usual diagnostic assessments. The patient assessment should determine the level and intensity of pain, what has relieved pain in the past, and how pain interferes with the patient’s quality of life. Additionally, information from family members, the patient interview, and a thorough assessment in concert with content obtained from a number of screening tools are used to define the patient’s addiction risks. These risks determine the appropriate levels of monitoring and follow up for best practices.
Patients need thorough education regarding opioid use. Therefore, nurses must emphasize the following information when opioids are initiated:
- Take opioid as prescribed, noting the importance of sticking with the dose regimen. Patients should know what to do if they miss a dose or if pain is not managed by the recommended doses.
- Remind patients that the medication should not be crushed or chewed.
- Warn patients of the dangers of using CNS depressants, including sedatives, alcohol, or illicit drugs.
- Reinforce the fact that due to the addictive nature of the drugs, discontinuation should be accomplished by tapering the drug’s dosing with primary care provider assistance.
- Drugs should never be shared. To avoid diversion, opioids should be locked up in a secure location.
- Potential side effects include death due to respiratory depression.
- The drug could impact one’s ability to drive, operate machines, or effect balance that could cause falls.
- Instruct the patient on safe disposal of unused opioids.
- Advocate the use of Naloxone
According to the ANA, overdose toolkits (created by SAMHSA) were released for use by the general public. They were designed to help save the lives of opioid patients and have increased in the US over the last few years. Naloxone is a medication that reverses the effects of opioids, including heroin and fentanyl when the first symptoms of respiratory arrest or coma occur. Intranasal administration has been available in the overdose tool kits since 2016.
- Raise Community Awareness
Nurses are often instrumental in providing community education. These educational sessions might be in schools, at hospitals, senior centers, or at other community locations. All aspects of opioid safety should be taught to interested, key community members to heighten awareness. The U.S. Department of Health and Human Services provides educational opportunities to partner with local community health experts and law enforcement to spread awareness.
The ANA advocates for all RNs, APRNs and NPs to be able to practice in the fullest extent of their education and practice authority for the implementation of patient treatment plans and access to care to combat pain and the opioid crisis. Students enrolled in Ottawa University’s Bachelor of Science in Nursing (RN-BSN) program have an opportunity to gain the skills and education needed to serve on the front lines of healthcare.
Graduates of our RN-BSN program will be prepared to further their education with a Master of Science in Nursing (MSN) degree online. OU’s MSN program is designed for the Registered Nurse (RN) who has graduated from an accredited program with a Bachelor of Science in Nursing (BSN) degree. Contact us today to see how Ottawa University can help you gain the skills you need to improve the quality of patient care and your career options.