Kathleen Broglio

American Society for Pain Management Nursing Position Statement: Prescribing and Administering Opioid Doses Based Solely on Pain Intensity

The foundation of safe and effective pain management is an individualized, comprehensive pain assessment, which includes, but is not limited to, determining the intensity of pain if the patient is able to report it. An unforeseen consequence of the widespread use of pain intensity rating scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity. Many factors in addition to pain intensity influence opioid requirements, and there is no research showing that a specific opioid dose will relieve pain of a specific intensity in all patients. The American Society for Pain Management Nursing (ASPMN) holds the position that the practice of prescribing doses of opioid analgesics based solely on a patients pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to untoward patient outcomes.

Pilot of an Online Introduction to Palliative Care for Nurses

Death is a common occurrence in the hospital setting. Research findings indicate that nurses lack knowledge and are uncomfortable with the care of seriously ill or dying patients. Most nurses report learning about end-of-life care through professional and personal experiences rather than their undergraduate programs. Education may improve nursing knowledge and ultimately behavior, but there are many competing mandatory education requirements. Any widespread education program must be brief, easy to administer, and available to nursing staff working different shifts. A 30-minute online introduction to palliative care (narrated PowerPoint presentation) was created and delivered to registered nurses (n = 23) working on a general medical unit. The Palliative Care Quiz for Nursing was administered prior to viewing the educational presentation, immediately after, and 3 weeks later. Average scores of 57.6% before education increased to 72.2% after the online session and were sustained at 70% 3 weeks later. Nurses believed the education was informative, and most indicated they would change their practice. Although many nurses would prefer a live presentation, there was acceptance of the online format. The results highlight deficiencies in palliative care nursing knowledge and provide direction for future nursing palliative care educational endeavors.

Left Ventricular Assist Devices: When the Bridge to Transplantation Becomes the Destination

Heart failure affects more than 5 million people in the United States. Left ventricular assist devices (LVADs), originally designed as a bridge to heart transplantation, are now implanted as either a bridge to transplantation or as a destination therapy for those individuals who are not transplant candidates. Left ventricular assist devices have improved survival and may improve the quality of life for many individuals. However, individuals who originally had LVADs implanted as a bridge to transplantation may be delisted because of changes in health status and, like those with LVADs as destination therapy, will live with this therapy until the end of life. Decision making can become more complicated when adverse effects or comorbid health conditions cause a significant decline in health status. Challenges related to informed consent, advance care planning, quality of life, and end-of-life care in this population will be discussed. Clinical interventions will be addressed to improve care in this growing population.

Assessing the Impact of the Position Paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity”

Background: A task force of members of the American Society for Pain Management Nursing (ASPMN) authored a position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity.” Some of the authors of this ASPMN position paper presented a concurrent session at the September 2016 ASPMN National Conference discussing the content of the position paper. As a follow‐up, the authors designed a research study to identify the impact of the position statement in facilitating change in institutional practice of dosing analgesics based solely on pain intensity. Aims: Our aim was to ascertain the effect of the American Society for Pain Management Nursing ASPMN position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity” (2016) on changes in institutional practices. Design: The study used an online anonymous questionnaire that included open‐ended questions. Settings: An anonymous electronic questionnaire was used to assess the impact across the United States. Participants/Subjects: Participants were members of the American Society for Pain Management Nursing. Methods: An eight‐question anonymous questionnaire created through Survey Monkey was sent to members of the American Society for Pain Management Nursing via an e‐mail listserv and the monthly e‐newsletter. Results: Of the 142 members who consented to participate in the study, 120 members answered one or more questions. Those who responded to the question about changes in practice, only 13 (11.1%) reported that the position paper had influenced a change in practice at their institution. The majority, 89 (75%), reported that practice had not changed in their institution. Conclusions: Among those clinicians who participated in this study, the position paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity” reportedly had minimal impact on changing institutional practices.

Medication-Assisted Treatment in the Perianesthesia Setting

IN 2015, ONE in 10 Americans (27 million) ages 12 or older used an illicit drug in the past month, and opioid pain relievers were the second most commonly used drug (3.8 million). Current trends in opiate morbidity and mortality include increased use of heroin and illicit synthetic fentanyl. More than 2 million people with a substance use disorder that included pain relievers (opioids) sought treatment in 2015. Treatment of opioid use disorder (OUD) may include the use of medications such as methadone, buprenorphine, and naltrexone. The use of these substances to treat OUD is referred to as medication-assisted treatment (MAT). In 2011, about 300,000 people received methadone in opioid treatment programs and more than 32,000 individuals were treated with buprenorphine. Because of recent legislation, nurse practitioners and physician assistants are able to prescribe buprenorphine as part of MAT, so the number of individuals receiving buprenorphine is expected to grow. Naltrexone is another emerging treatment option for OUD that may be effective for other types of addiction such as alcohol use disorder.

Referring patients to hospice or palliative care.

NPs care for patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, cancer, and dementia. As the disease progresses or patients age, disease-related symptoms may become increasingly burdensome, and these patients may benefit from hospice or palliative care. NPs can guide individuals in this process to optimize care and support at the end of life.