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Goal-Directed Opioid Stewardship in Acute-on-Chronic Nonmalignant Pain Management

      Highlights

      • Opioid abuse is a growing problem in the United States.
      • Prescription opioids are a major source of misused opioids and overdose deaths.
      • Pain management in those with chronic pain experiencing an acute exacerbation can be complex with few pain management providers available in the acute care settings.
      • Balancing pain management with opioid stewardship can be achieved through shared decision making with patients and providers.
      • Implementation of acute care pain management guidelines can support providers to decrease opioid prescriptions through risk screening, comprehensive assessments, and patient education.

      Abstract

      Prescription opioids were identified as being responsible for 14,000 deaths in 2019, with 9.3 million people admitting to misuse in 2020. This quality improvement project implemented the Institute for Clinical Systems Improvement (ICSI) guideline on pain management in acute care to decrease opioid prescriptions >90 morphine milliequivalents for acute-on-chronic pain. The change to current practice included completion of comprehensive functional assessments and opioid risk screening tools to guide a goal-directed shared decision-making discussion with patients. There was a statistically significant decrease in morphine milliequivalents per prescription (t43 = 2.579, P = .013).

      Keywords

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      Biography

      Ginger LeAnn Holloway, MSN, FNP-BC, AGACNP-BC, is a DNP student at the University of South Alabama College of Nursing, Mobile, AL, and can be contacted at [email protected]

      Biography

      Audrey Jane Weymiller, PhD, FNP-BC, ACHPN is a nurse practitioner at Washington Regional Medical System, Fayetteville, AR.

      Biography

      Angelique Allemand, DNP, FNP, AGACNP is faculty at the University of South Alabama College of Nursing, Mobile, AL.