Main Concepts Presented in the Modules
Although opioid is a beneficial prescription for chronic pains, it is associated with risks such as opioid dependence and drug overdose. Besides, when opioid is used in the treatment of acute pain, there are high chances of long-term uses. Additional factors in the form of old age, pregnancy, mental health disorder, substance abuse, and sleep-disordered breathing also increases the risk of harm from the use of opioid prescriptions. Therefore, opioid ought to be administered in a manner that utilizes its benefits and minimizes the risks. The CDC guideline for the administration of opioids for chronic pain puts forward twelve recommendation that should be used by medical practitioners.
The CDC guideline provides directions on when to start or continue with the prescription of opioids for chronic pain. Opioids should not always be the first consideration when prescribing for pain. Before prescribing, the anticipated benefits should be measured against the possible risks to the patient. If the benefits outweigh the risks, a prescription may be given. However, it is advisable to combine opioids with nonpharmacologic therapy. At the start of prescription, clinicians must set treatment goals in terms of pain reduction, and lay down guidelines on how the treatment will be discontinued should the prescription not bring the desired results. Throughout the prescription period, clinicians should discuss the known risks and benefits with the patient. It is the role of the medical practitioner to determine when to prescribe, discontinue, and manage opioid prescription.
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Primary caregivers have the responsibility of determining the best selection, dosage, duration, and discontinuation of opioid medication. Whenever administration is initiated, immediate-release opioids should be the first consideration. Also, clinicians are advised to prescribe the lowest effective dosage, with subsequent increases being approved after a thorough assessment of benefits and risks to the patient. However, at no time should a patient receive a dosage that is greater than 90 morphine milligram equivalents (MMA) per day. Clinicians should not prescribe higher than expected dosage within the duration of treatment. Furthermore, consistent monitoring of progress should be done to examine development since the initiation or increase of dosage. If harms outweigh benefits, practitioners should consider that therapies and terminate or reduce opioid intake by patients. Throughout the period, clinicians should ensure that the right form and dosage, in proper quantities, are administered to their patients.
Risk assessment and response is an integral part of opioid prescription. Before the commencement of and during opioid therapy, practitioners should assess potential risks associated with opioid intake. Risk mitigation, such as the use of naloxone for patients who are more prone to overdose, is critical to reducing the dangers to patients. Therefore, the Prescription Drug Monitoring Programs (PDMP) data should be employed to check for parallel dosage or dangerous combinations that might put patients at a higher risk for overdose. Subsequent tests, such as urine drug testing, must also be administered prior and during the prescription period to annihilate any chance of an overdose. If necessary, clinicians might be required to attend to patients with opioid use disorder. The clinician must always assess and respond to potential risks associated with opioid intake to ensure the safety of patients.
Despite the risks associated with opioid usage, physicians might be required to prescribe this medication, particularly for chronic pain. Therefore, clinicians must take up the responsibility of ensuring that opioid prescriptions do not harm their patients. Practitioners should, therefore, follow the CDC guideline, compare the benefits and risks of administration, employ the PDMP, and compute the daily opioid dosage for safer administration.
Plan for Opioid Prescribing as an Advanced Practice Registered Nurse
Nurses have the responsibility to follow state and countrywide guidelines for safe opioid administration to protect individual patients, the public, and themselves, in the incident that they become persons of interest in an investigation (Hudspeth, 2016a). Nurses might find themselves in trouble if they fail to appropriately administer pain prescriptions, fail to meet the pain management care standards as per the boards of nursing, and fail to manage personal pain medication use to the extent that it impacts on their performance. Therefore, nurse practitioners have a huge role in addressing the current opioid crisis.
According to the national standards, patient history and assessment are essential activities that must precede any opioid prescription (Hudspeth, 2016a; Naegle, Mitchelle, Flinter, Dunphy, Vanhook & Delaney, 2017). The documentation should include medical history, including pain history details as well as the description of other issues that relate to opioids, such as cognitive impairment and pulmonary disease, among others. Also, a nurse should also assess the treatment history, as well as aggravating factors and relieving factors. The initial assessment should also include additional parameters that are specific to patients who will be put under opioid medication. These include the social history, drug history, alcohol usage history, urine drug test (UDT), depression screening, and the review of the PDMP (Hudspeth, 2016a). To get a reliable results, various tools, such as Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain (SOAPP) can be employed. Patient history and assessment are the first two activities towards a successful prescription of opioid dosages. The employment of pain care standards and ethical principles throughout these activities will facilitate safer opioid prescription as well as the protection of a certified nurse practitioner.
After reviewing patient history and assessment, the nurse will decide on whether to prescribe opioid or not. If an opioid is prescribed, it should first be administered as a trial (Hudspeth, 2016b). Subsequent monitoring through intermittent risk assessment, UDT, and monitoring reports will determine as to whether the dosage will be increased, decreased, or terminated. The patients must also be informed about every possible option, the risks, and benefits of using opioid. As a primary caregiver, nurses have the responsibility of ensuring that patients prescribed to opioids are safe through the management of the entire prescription by determining when to use opioid prescription, the duration of usage, the dosage and form, other types of therapy to be used, and when to terminate the opioid administration.
The American Nurses Association (ANA) advocates for the increased usage of PDMPs. Advanced Practice Registered Nurses (APRNs) should use PDMPs to prevent inappropriate access to prescription opioids (American Nurses Association, 2016). In addition, PDMPs also guide nurses on the best dosage based on the information of current and historical usage that can be found on these programs. However, although PDMPs are meant to improve safe and correct prescriptions, it should not serve as a barrier to appropriate pain management for individuals who genuinely need opioid prescriptions.
The nurses should also increase access to naloxone to caregivers who are documented to be chronic users of opioids. An opioid antagonist is a vital tool in preventing fatalities from an opioid overdose. Aside from nurses administering Naloxone, the drug should be made accessible to other first responders, family, and friends of chronic opioid users (American Nurses Association, 2016). The combination of appropriate prescription with easy access to Naloxone will help mitigate the risks and harm associated with opioid prescription while utilizing its ability to treat chronic pain.
In conclusion, opioid is a strong prescription for chronic pain with significant risk to its users. APRNs have the responsibility of ensuring that the benefits of usage outweigh risks whenever it is administered. The state and national guideline for the prescription of opioid for chronic pain can be used to guide nurses on the best practice principles that protect patients, the public, and themselves.
References
American Nurses Association. (2016). Nursing's role in addressing nation's opioid crisis.
Hudspeth, R. S. (2016a). Safe opioid prescribing for adults by nurse practitioners: Part 1. Patient history and assessment standards and techniques. The Journal for Nurse Practitioners , 12 (3), 141-148.
Hudspeth, R. S. (2016b). Safe opioid prescribing for adults by nurse practitioners: Part 2. Implementing and managing treatment. The Journal for Nurse Practitioners , 12 (4), 213-220.
Naegle, M., Mitchell, A. M., Flinter, M., Dunphy, L., Vanhook, P., & Delaney, K. R. (2017). Opioid misuse epidemic: Addressing opioid prescribing and organization initiatives for holistic, safe and compassionate care. Nursing Outlook , 65 (4), 477-479.
