Opioids have become a leading cause of unintentional injury death in Washington, even more than motor vehicle accidents or firearm fatalities, according to 2016 state data. Nationwide, the Centers for Disease Control and Prevention (CDC) reports that overdose deaths related to prescription opioids have quadrupled since 1999. Nurses can play an important role in reducing these deaths, as well as addiction problems, through their assessments and monitoring of patients. Show The depth and breadth of prescription opioid abuse is far-reaching. A 2016 study published in the Journal of the American Medical Association (JAMA) by Baker and colleagues notes that there is significant variability in the amount of opioids prescribed. The most commonly dispensed opioid was hydrocodone (78 percent), followed by oxycodone (15.4 percent). Every day, more than 1,000 people are treated in emergency departments for misusing one of these prescription opioids. In 2014, almost 2 million people in the United States abused or were dependent on prescription opioids. At least half of all opioid overdose deaths involve a prescription opioid and strike a wide adult population, with prescription opioid overdose rates between 1999 and 2014 highest among people age 25 to 54, according to the CDC. But there may be a course correction underway. A 2015 study in the American Journal of Preventive Medicine reported a decrease in the rate of prescribing opioids (- 5.7 percent), perhaps indicating that more healthcare providers are becoming aware of the addiction issue. At the same time, it’s important for nurses to be well aware of steps they can take to help protect themselves from possible legal action stemming from opioids. Assess the patient carefully A physical exam should also be completed, keeping in mind signs and symptoms of possible substance abuse, such as advanced periodontitis, traumatic lesions and poor oral hygiene. If patients are already being managed for chronic pain, the nurse should consult with the appropriate provider. Screen and
refer patients Nurses also can help detect patients with substance misuse with the National Institute on Drug Abuse Quick Screen (NIDA). If a substance use disorder is suspected, the nurse should remain nonjudgmental while referring patients for further evaluation and treatment, so they receive the care they need. Nurses need to closely monitor patient use of controlled drugs to avoid overdependence or potential addiction, and refer chronic pain patients to a pain management center or specialist. Be sure to document the referral in the patient’s health record. Nurses also should consider referral for patients who seek opioids beyond when they are likely to be needed. Apply evidence-based pain management NSAIDs have been shown to be at least as effective (if not more so) than opioids for managing pain, particularly in combination with acetaminophen. Before patients begin taking NSAIDs, verify that they are not taking other anticoagulants, including aspirin, and check for hepatic or renal impairment. Nurses should complete continuing education courses in pain management and document they did so, which can provide evidence of their knowledge in event of legal action. Educate patients Verbal and written instructions after the procedure need to contain name of drug, dosage, adverse effects, how long the drug should be taken and how to store it. Results from a 2016 survey published in JAMA Internal Medicine found that more than half (61 percent) of those no longer taking opioid medication keep it for future use, so patients need to be told to dispose of unused drugs and how to do so. Patients can search for places that collect controlled substance drugs through the Drug Enforcement Administration at www.deadiversion.usdoj.gov. The same survey found that about 20 percent shared the opioid with another person, so education material should mention not to do this. Nurses should also discuss the perils of driving or undertaking complex tasks while taking an opioid. Document in the patient’s health record that this information was provided and the patient acknowledged receipt and understanding. An office visit can also provide the opportunity for nurses to address opioid abuse on a larger scale. Below are some considerations for the use of pain medication in patients:
Nurses who assess and monitor patients for treatment of pain are encouraged to be mindful of and have respect for their inherent abuse potential. Doing so helps protect patients from harm and nurses from potential liability. About the author David Griffiths is senior vice president of program management for Nurses Service Organization (NSO), where he develops strategy and oversees execution of all new business acquisition and customer retention for the group’s allied healthcare professional liability insurance programs. With more than 15 years of experience in the risk management industry, he leads a team covering account management, marketing and risk management services. More at www.nso.com. This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 650,000 nurses since 1976. INS endorses the individual professional liability insurance policy administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to or call 1-800-247-1500. www.nso.com. This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter. Resources
What precautions should a person take if they prescribed an opioid?How can I take my opioid medicine safely?. Take your medicine exactly as prescribed - do not take extra doses.. Check the instructions every time you take a dose.. Do not break, chew, crush, or dissolve opioid pills.. Opioids can cause drowsiness. ... . Contact your provider if you have side effects.. What are the nurses responsibilities when administering an opioid analgesic?Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events.
Which of the following is used to treat opioid addiction?Buprenorphine, methadone, and naltrexone are used to treat opioid use disorders to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.
|