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Development and Implementation of the FAST-PACE Assessment Framework and Tiered Analgesic Orders for Opioid Optimization
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.058
Lena Ngo RN, MSN, CNS , Marilyn Bazinski DNP, AGCNS, RN, PMGT-BC
{"title":"Development and Implementation of the FAST-PACE Assessment Framework and Tiered Analgesic Orders for Opioid Optimization","authors":"Lena Ngo RN, MSN, CNS ,&nbsp;Marilyn Bazinski DNP, AGCNS, RN, PMGT-BC","doi":"10.1016/j.pmn.2025.01.058","DOIUrl":"10.1016/j.pmn.2025.01.058","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this presentation is to share how one academic medical center adopted a holistic pain assessment framework and multimodal order sets to guide administration of analgesic therapies.</div></div><div><h3>Summary of Evidence</h3><div>Significant patient harms have been attributed to opioids, so stewardship programs are required. The CDC and an international panel of health care professionals recommends administering opioids to functional outcomes. Change was instigated by revised inpatient order sets and creation of a holistic framework. These methods aim to address patient-specific recovery goals and minimize long and short-term adverse effects while support nursing practice.</div></div><div><h3>Validation of Evidence</h3><div>Revised opioid-sparing order sets and staff and patient education modules will be reviewed. Analysis of how FAST-PACE guides prescribing or administering analgesia will be described. Learn how Plan-Do-Study-Act process improvement guides ongoing interdisciplinary Opioid Optimization workgroup actions. Consider preparation for a second regulatory survey since implementing this practice change. Discuss importance of just-in-time education to support clinician, and patient/caregiver adoption of this evidence-based process.</div></div><div><h3>Results/Relevance to Pain Management</h3><div>Revised opioid-sparing order sets rolled out in March of 2022; A significant practice change entailing ongoing evaluation and reinforcement. No patient harms have been directly attributed to this practice change. Metrics to measure quality, safety and nursing adherence to the tiered approach are underway. Existing EPIC workbench reports display 80-90% provider conformity to the tiered, multimodal approach.</div></div><div><h3>Future Implications for Nursing Practice</h3><div>Changing from the former ubiquitous method of dosing opioids to pain intensity scores will take time. Both patients and staff will benefit from routine reinforcement and rationale for this practice change. Patient well-being, function, and risk mitigation are the driving forces behind this initiative.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e227"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Review of Multimodal Therapies for the Treatment of Neuropathic Pain: Clinical Implications
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.063
Jeffrey Bettinger PharmD , Sri Nalamachu MD
{"title":"Review of Multimodal Therapies for the Treatment of Neuropathic Pain: Clinical Implications","authors":"Jeffrey Bettinger PharmD ,&nbsp;Sri Nalamachu MD","doi":"10.1016/j.pmn.2025.01.063","DOIUrl":"10.1016/j.pmn.2025.01.063","url":null,"abstract":"<div><h3>Purpose</h3><div>We summarize the safety and efficacy data from three gabapentinoid (GABA) combinations: GABA + opioid; GABA + antidepressants; and GABA + topical lidocaine and evaluate the benefit risk from each combination.</div></div><div><h3>Methods</h3><div>Using a recently published systematic review, we identified combination studies of neuropathic pain. In addition, we reviewed publications of GABA + topical lidocaine.</div></div><div><h3>Results</h3><div>GABA + opioid: We reviewed 6 studies evaluating the combination of an opioid with a GABA (931 total participants). Efficacy results were mixed in this combination. Combination therapy was shown to be superior to monotherapy in some studies, but not in all. Significant AEs were noted with this combination treatment. There were also higher rates of dropouts related to AEs in the combination arm compared to monotherapy. GABA + antidepressant: We reviewed 3 studies evaluating the combination of GABA and antidepressant (472 participants). Efficacy results were mixed in this combination, with combination therapy shown to be superior to monotherapy in some studies. There were no differences in dropouts due to AEs between combination and monotherapy arms. GABA + topical lidocaine: We reviewed 2 studies evaluating the combination of GABA and topical lidocaine (205 participants). Combination therapy was shown to be efficacious in reducing pain from baseline; however, both studies were limited in that both were open-label. The incidence of treatment-related adverse events was low and typically mild to moderate in severity.</div></div><div><h3>Conclusions</h3><div>Achieving meaningful pain relief in patients suffering from neuropathic pain can be challenging. There are limited effective options available to treat neuropathic pain and the majority are administered systemically resulting in adverse events that primarily affect the CNS, leading to functional limitations and discontinuation of drugs. Combinations of two systemic agents (GABA + opioid, GABA + antidepressants) have resulted in significant AEs and dropouts in clinical studies. On the other hand, combinations of a systemic agent and a topical agent (GABA + topical lidocaine) can confer improved efficacy with minimal additional adverse effects.</div></div><div><h3>Nursing Implications</h3><div>Topical medications with minimal systemic AEs such as lidocaine patch have shown to be beneficial in many neuropathic pain conditions and may be of benefit to achieve meaningful pain relief in more patients as an adjuvant therapy. Nurses are at the forefront of patie</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e228-e229"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opioid related Transitions: Management considerations for patients with pain that utilize prescribed opioids
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.065
Lisa Carnago MSN, BSN, RN, FNP-C
{"title":"Opioid related Transitions: Management considerations for patients with pain that utilize prescribed opioids","authors":"Lisa Carnago MSN, BSN, RN, FNP-C","doi":"10.1016/j.pmn.2025.01.065","DOIUrl":"10.1016/j.pmn.2025.01.065","url":null,"abstract":"<div><h3>Problem Statement</h3><div>Pain is a leading reason people seek healthcare services, and approximately 20% of individuals with chronic pain in the United States rely on prescribed opioids as part of their pain management approach. Navigating healthcare is challenging for those that use an opioid for pain management and for the clinician requires multi-step processes and complex decision-making. Adding complexity for both patients and clinicians are transitions of care, which are movements between settings, services, practitioners and levels of care. Understanding, anticipating, and preparing for transitions that involve an opioid, called opioid related transitions (OrT), will assist nurses with optimizing pain care for people using opioids for pain management.</div></div><div><h3>Purpose</h3><div>The purpose of this session will be to describe OrT, explain the clinical importance of OrT for patients with pain that use opioids, and strategies for nurses, including advanced practice nurses, to optimize pain care when opioids are prescribed.</div></div><div><h3>Methods</h3><div>Following Rodgers Evolutionary method for concept analysis, key attributes of an OrT will be described. Case studies will be presented to underscore the defining attributes and clinical implications of OrT.</div></div><div><h3>Results</h3><div>OrT are a specific transition of care that involves a prescribed opioid and is a vulnerable period for patients with pain. OrT attributes occur during interactions between the patient and the prescribing clinician and include communication, responsibility, knowledge, risk, and decision-making.</div></div><div><h3>Conclusions &amp; Relevance to Pain Management</h3><div>OrT can lead to fragmented and suboptimal care, raise patient safety concerns, increase the risk of adverse events, and result in suboptimal pain management. Enhancing nurse awareness of OrT involves identifying different types of OrT and clarifying the essential roles of clinicians and healthcare systems in supporting patients navigating these transitions.</div></div><div><h3>Future Implications for Nursing Profession</h3><div>Highlights of this talk include implications for nursing and clinician practice to support patients experiencing an OrT. Strategies discussed will include communication during transitions, needed education (e.g. opioid tapering, prescribing recommendations), assessing and monitoring medication response and risk mitigation.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e229"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of an opioid stigma scale for individuals living with chronic pain
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.061
Lisa Carnago MSN, BSN, RN, FNP-C
{"title":"Development of an opioid stigma scale for individuals living with chronic pain","authors":"Lisa Carnago MSN, BSN, RN, FNP-C","doi":"10.1016/j.pmn.2025.01.061","DOIUrl":"10.1016/j.pmn.2025.01.061","url":null,"abstract":"<div><h3>Background</h3><div>High levels of stigma experienced by patients with chronic pain contribute to negative effects on psychological well-being and opioid use. Current opioid stigma measures have not focused on opioid stigma experiences among individuals with chronic pain who may have legitimate need for opioid use for pain management.</div></div><div><h3>Purpose</h3><div>We created a measure of opioid stigma that captures two constructs: perceived stigma (awareness of others’ negative attitudes) and internalized stigma (application of stereotypes to oneself) of opioid use for patients with chronic pain.</div></div><div><h3>Methods</h3><div>We recruited 180 participants with chronic pain via the online platform CloudResearch to modify an existing stigma scale. Collaborating with two stigma experts and two patients with chronic pain, we developed items related to perceived stigma (8 items) and internalized stigma (5 items). Items were assessed using a 6-point Likert-type scale. Concurrent and discriminant validity were evaluated using the Center for Epidemiologic Study Depression Scale-10, Rosenberg Self-Esteem, and Brief Resilience Scales. Factor structure and item selection were based on Iterated principal factor analysis with Promax rotation, guided by scree plot, Kaiser criteria, and factor loadings above .30. We report item-partial correlations with the respective factor controlling for the influence of the other factor.</div></div><div><h3>Results</h3><div>A sample of 151 participants, largely Caucasian (80%), between 30-39 years old (40%) and with historical opioid use (81%) were included. A two-factor solution was identified (MSA=.90), including perceived and internalized stigma (Eigenvalues 7.23, 2.53, respectively, inter-factor correlation= .45, alphas=.94, .94). Theorized semi-partial item correlations for perceived stigma ranged from .61-.78 and internalized stigma .73-.82. Significant correlations were observed between perceived stigma and CESD-10 (0.19, p=0.02), and internalized stigma and resilience (-0.26, p=.001).</div></div><div><h3>Conclusion</h3><div>This measure of perceived stigma and internalized stigma for individuals with chronic pain shows promising psychometric properties with strong reliabilities, and support for concurrent and discriminant validity.</div></div><div><h3>Implications for Nursing Practice and Research</h3><div>Further study is needed to confirm this scales’ psychometric properties with a more representative sample utilizing longitudinal methods. This scale will advance studies of stigma and psychological well-being for patients with chronic pain.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e228"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neonatal Pain Management
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.050
Deb Bruene MA, RN, PMGT-BC
{"title":"Neonatal Pain Management","authors":"Deb Bruene MA, RN, PMGT-BC","doi":"10.1016/j.pmn.2025.01.050","DOIUrl":"10.1016/j.pmn.2025.01.050","url":null,"abstract":"<div><div>The purpose of this presentation is to present an evidence-based update related to neonatal pain management. By 23-25 weeks, the infant nervous system is able to perceive pain. It has been well-documented that NICU infants undergo 7.5 -17.3 painful procedures per day. Nurses play a key role in providing evidence-based interventions to prevent procedural pain. Neonates are completely dependent upon caregivers, especially nurses at the bedside, to recognize (assess) pain, provide appropriate multimodal interventions, and reassess effectiveness. Bedside nurses caring for neonates and infants must be skilled in identifying potential sources of pain and assessment of pain in a completely vulnerable population. Poorly controlled pain negatively impacts the developing brain leading to negative short and long term outcomes including hyperalgesia, altered cardiovascular responsiveness to nociceptive stress into adulthood, reduced white matter integrity, neuronal loss, long-term behavioral changes and many other negative sequelae from poorly controlled pain. While managing neonatal pain is vital to promote brain growth, nurses must be aware of unique aspects of pharmacologic interventions due to immature organ systems as well as potential implications associated with rapid brain development and analgesia administration. Newer modalities such as regional analgesia and medications such as dexmedetomidine show promise in relieving pain while minimizing harmful side effects. Additionally, nurses have the primary responsibility for utilization of evidence-based, non-pharmacological interventions to prevent pain and minimize the potential for harmful side effects which can be associated with pharmacologic interventions.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e224"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Apply to Affected Area – Sticking to the Pharmacology of Topical Analgesics
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.052
Nicole Schaberg PharmD, BCPS
{"title":"Apply to Affected Area – Sticking to the Pharmacology of Topical Analgesics","authors":"Nicole Schaberg PharmD, BCPS","doi":"10.1016/j.pmn.2025.01.052","DOIUrl":"10.1016/j.pmn.2025.01.052","url":null,"abstract":"<div><div>Concurrent depression and persistent pain continue to be prevalent among over a quarter of adult patients seeking specialized pain management support. Individuals who have an underlying psychiatric illness will report greater pain intensity, more pain-related disability, and a larger affective component to their pain. Clinical evidence will be provided to review the physiology of depression and persistent pain with relevant pharmacological considerations related to various classes of antidepressant therapies. Optimized antidepressant agent selection with incorporation of pertinent side effects, drug-interactions, and monitoring will be discussed. Front line staff will be able to further engage in medication reconciliation, identify and coordinate pharmacological needs with other care teams, and aid in patient and staff education and normalization of concurrent depression and persistent pain.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e225"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing Perioperative Pain Outcomes in Substance Use Disorder and Chronic Pain
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.053
Maria Rubino MSN, PMGT-BC, Marie O'Brien DNP, ANP-C, PMGT-BC, CCRN
{"title":"Optimizing Perioperative Pain Outcomes in Substance Use Disorder and Chronic Pain","authors":"Maria Rubino MSN, PMGT-BC,&nbsp;Marie O'Brien DNP, ANP-C, PMGT-BC, CCRN","doi":"10.1016/j.pmn.2025.01.053","DOIUrl":"10.1016/j.pmn.2025.01.053","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Improve perioperative pain control for patients with substance use disorder (SUD) and/or chronic pain through a advanced practice registered nurse (APRN)-led program that proactively supports this vulnerable population through care coordination &amp; patient education.</div></div><div><h3>Summary</h3><div>Patients with SUD and/or chronic pain have high prevalence of uncontrolled postop pain. The complexity of medication assisted treatment (MAT)/chronic opioid therapy complicates pharmacologic management of pain during the periop period. This marginalized group often has increased length of stay and decreased patient satisfaction. Evidence-based practice guidelines and professional organization recommendations support pre-admission care coordination with pain expert for patient specific guidance, education and pain regimen planning that includes input from the patient.</div></div><div><h3>Methods</h3><div>APRN led program identified best practice recommendations to facilitate pre-admission care coordination for patients at risk for uncontrolled postop pain. Through collaboration with Presurgical testing, community surgeons, patient access &amp; public affairs, a Transitional Pain Consultation program provides a preadmission virtual consult with APRN pain expert to provide patient specific guidance in regards to MAT and/or chronic opioid therapy. Recommendations provided to surgeon, anesthesia provider &amp; nursing staff ensures optimal medication regimen. Transitioning patient back to home MAT regimen or community pain provider closes the loop to enhance patient experience.</div></div><div><h3>Results</h3><div>Prior to implementation, at risk patients experienced unneccary uncontrolled postop pain due to lack of coordination and understanding of the complexities of MAT. Patients with SUD often suspended MAT preop fear of uncontrolled pain &amp; lack of understanding newer guidelines for continuation of MAT in the peri-op window.</div><div>Data collected demonstrates the number of consults increasing from 5 per month to 20 per month with collaboration of patient access and public affairs, continuation of MAT peri-op increasing from 0% prior to 80% with pre-op APRN consultation. Patient satisfaction with program demonstrates 90% of patients who compete the consult endorse feeling heard and would recommend this program to other patients.</div></div><div><h3>Future Implications for Nursing</h3><div>Patient outcomes improve when evidence-based resources are implemented to facilitate patient comfort and support transitions of care for vulnerable patients with SUD and/or chronic pain. Strategies for replication of this best practice model of nurse autonomy will be shared.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e225"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perceived Racial Bias in Medical Settings by Black Adolescents and Young Adults with Sickle Cell Disease
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.022
Renee C.B. Manworren PhD, RN-BC, APRN, PCNS-BC, AP-PMN, FAAN , Vanessa Williams BS
{"title":"Perceived Racial Bias in Medical Settings by Black Adolescents and Young Adults with Sickle Cell Disease","authors":"Renee C.B. Manworren PhD, RN-BC, APRN, PCNS-BC, AP-PMN, FAAN ,&nbsp;Vanessa Williams BS","doi":"10.1016/j.pmn.2025.01.022","DOIUrl":"10.1016/j.pmn.2025.01.022","url":null,"abstract":"<div><div>Sickle cell disease (SCD) is the most common genetic disorder of people of African descent. The primary reason for healthcare use among people with SCD is for severe acute vaso-occlusive crisis (VOC) pain. However, Black adolescents &amp; young adults (AYAs) are less likely to receive opioids for severe pain. This disparity may be racially motivated.</div><div>The purpose of this study is to characterize racial bias events experienced by Black AYAs in community &amp; medical settings. Our aim is to gain a better understanding of racial biases and stress associated with racial bias among Black AYAs.</div><div>In this prospective, mixed methods study, we used the 14-item Perceptions of Racism in Children and Youth (PRaCY) questionnaire. Scripted follow-up interviews were conducted by Black young adults who are not health care providers. All study procedures were conducted by phone, recorded, and transcribed using MS Teams. Here we describe initial findings from interviews with 12 Black AYAs with SCD, 10-23 years of age, who received care at an urban, not-for-profit, university-affiliated medical center.</div><div>Perceived racial bias in medical settings were reported by 8 of 12 AYAs interviewed. Reports of perceived racial bias were more common in the emergency room (n=5) than a clinic appointment (n=3). Additionally, 4 of the 12 AYAs reported they were treated differently than other children in the hospital. Racial bias was perceived from medical staff rudeness and pain being discounted by HCPs.</div><div>The results of this study will help nurses develop effective methods to address differential medical treatment, poor pain management and negative health outcomes experienced by Black AYA because of racial bias in medical settings. Recruitment for this study is ongoing. Content analysis is still needed to identify themes from the post-PRaCY interviews.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e216-e217"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opioid Wastes Among Patients with Cancer: A Retrospective Electronic Health Record Review
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.023
Karen Alsbrook PhD, RN, OCN
{"title":"Opioid Wastes Among Patients with Cancer: A Retrospective Electronic Health Record Review","authors":"Karen Alsbrook PhD, RN, OCN","doi":"10.1016/j.pmn.2025.01.023","DOIUrl":"10.1016/j.pmn.2025.01.023","url":null,"abstract":"<div><div>Problem: Opiophobia, or fear of opioids, is associated with undermanaged pain in patients with cancer. However, to our knowledge, research of documented reasons for opioid underutilization in patients with cancer is lacking. Learning the reasons patients refuse opioids as prescribed during hospital encounters may be key in mitigating opiophobia-driven poor adherence to prescribed opioids.</div><div>Purpose: To identify reasons for opioid wastes recorded by nurses in the electronic health record for one year at all locations of a comprehensive cancer center.</div><div>Methods: This descriptive study was a retrospective review of opioid wastes during 2023. Using directed content analysis, deidentified opioid wastes were categorized as intentional, accidental, or patient-related. Intentional wastes resulted from orders, policies, patient death, or pulls for wrong drug, patient, or time. Accidental wastes were unintentional (e.g., dropped on floor). Patient-related wastes were due to patient refusal or condition (e.g., nausea). Patient-related wastes were further categorized using predetermined reasons.</div><div>Results: Of 1,914 opioid wastes, most (n=1,069, 56%) were intentional and 224 (12%) accidental. 618 (32%) were patient-related; 77% (n=477) were patient refusals with 141 (23%) due to patient condition. Most patient refusals (n=477) were for no given reason (57%, n=272); requests for a different form of opioid, such as oral vs. intravenous (13.2%, n=63); or requests for a different opioid, such as tramadol vs. morphine (5.7%, n=27). Other refusals were requests for non-opioid analgesics (1.5%, n=7) or other medication (3.4%, n=16); reports of prior adverse effects (4.6%, n=22); requests for unscheduled opioid (0.4%, n=2) or another administration time (3.6%, n=17); considered opioid too strong (2.5%, n=12) or too weak (2%, n=10); family influenced (3.4%, n=16); or spat out (2.7%, n=13).</div><div>Implications: Most opioid wastes in 2023 were intentional. This finding was expected, as nurses must perform protocolized wastes (e.g., unused patient-controlled analgesia pumps) in health care settings. Few were due to accidents (e.g., loss of venous access, dropping, defective package). Most patient-related wastes were refusals for no given reason whose last known pain scores ranged from 0 to 10 with an average score of 4.5 and median score of 5.</div><div>Possibly, some refusals are influenced by opioid-related fears, including fear of side effects. Opiophobia may be amenable to intervention, which could improve pain outcomes.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e217"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Revolutionizing Healthcare Dynamics: An Innovative Masterclass on Conflict Management, Psychological Safety and Stellar Communication for Nurses and Nurse Practitioners
IF 1.6 4区 医学
Pain Management Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.pmn.2025.01.089
Michelle Lavelle-Henry APRN, ACHPN CNP, PMGT-BC, ACHPN , Scott Faust Ed.D, MS, APRN, CNP, ACNP-BC, ACNP-C, ACHPN, CEN, CNMAP, PHN
{"title":"Revolutionizing Healthcare Dynamics: An Innovative Masterclass on Conflict Management, Psychological Safety and Stellar Communication for Nurses and Nurse Practitioners","authors":"Michelle Lavelle-Henry APRN, ACHPN CNP, PMGT-BC, ACHPN ,&nbsp;Scott Faust Ed.D, MS, APRN, CNP, ACNP-BC, ACNP-C, ACHPN, CEN, CNMAP, PHN","doi":"10.1016/j.pmn.2025.01.089","DOIUrl":"10.1016/j.pmn.2025.01.089","url":null,"abstract":"<div><div>Purpose, problem statement: Conflict management is integral to effective pain management nursing practice, yet nurses often lack comprehensive training in this area. This abstract outlines the development and implementation of a conflict management training program tailored specifically for nurses specializing in pain management. The program aims to address the lack of formalized conflict resolution training within this specialized field, ultimately enhancing patient care outcomes and promoting a supportive work environment.</div><div>Method of Evaluation/Validation of Evidence: The development of the conflict management training program draws upon evidence-based practices in conflict resolution, adult learning principles, and input from pain management nursing experts. The program design incorporates interactive workshops, case studies, role-playing exercises, and peer-to-peer discussions to facilitate active learning and skill acquisition. Evaluation methods include pre- and post-training assessments, participant feedback surveys, and observational data to measure the program's effectiveness in enhancing conflict management competencies among nurses.</div><div>Summary/Synthesis of Evidence: The evidence supporting the need for conflict management training in pain management nursing stems from various sources, including studies highlighting the prevalence of workplace conflicts and their detrimental effects on patient care and staff morale. Additionally, literature emphasizes the importance of effective communication and collaboration in pain management settings, underscoring the necessity for conflict resolution skills among nursing professionals.</div><div>Results/Relevance to Pain Management: Preliminary results indicate a significant improvement in nurses' confidence and proficiency in managing conflicts related to pain management scenarios post-training. Participants report enhanced communication skills, increased knowledge of conflict resolution strategies, and greater collaboration within interdisciplinary teams. These findings underscore the relevance of targeted conflict management training in improving patient care quality and fostering a positive work environment within pain management settings.</div><div>Future Implications for Nursing Profession: The implementation of conflict management training programs tailored to the unique needs of pain management nurses holds promising implications for the nursing profession. By equipping nurses with essential con</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e237-e238"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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