Opioid Safety

How Nurses Can Fight The Opioid Epidemic

In this article published in the February 2018 issue of Hospital News, Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety) discusses how nurses can fight the opioid epidemic. Mr. Wong cites resources, such as the PCA Safety Checklist, and harm reduction principles set forth in the Canadian Nurses Association paper, “Harm Reduction & Illicit Substance Use: Implications for Nursing.”

The US and Canada are both battling the opioid epidemic. As Michael Wong, JD (Founder & Executive Director, Physician-Patient Alliance for Health & Safety) writes in the article, “How Nurses Can Fight The Opioid Epidemic”:

With the U.S. and Canada in the throes of an ‘opioid epidemic’, much of the policy making has focused on stemming the rate of prescription practices. In many ways these efforts are working; a recent Global News report revealed that the total number of people prescribed opioids in Ontario remained stable, with an 18% decrease in total opioid volume of 2 years. In the U.S., a CDC report found that opioid prescriptions fell by the same amount (18%) from 2010 to 2015 but with high variability from county to county.

These are promising first steps, but the reality is that clinicians continue to battle an increase in opioid-related deaths. In 2014, 2015 and 2016, the B.C. government identified 366, 513, and 922 illicit substance overdose deaths, respectively, demonstrating an exponential increase in overdose-related fatalities.

Mr. Wong discusses what clinicians, and particularly nurses, can do to fight the opioid epidemic in both in the hospital and outside of the hospital setting –

(1) Preventing Opioid-Related Harm In Hospitals

Nurses can play a critical role in preventing opioid-related adverse events and patients by helping to ensure safe opioid use by:

  • Not relying upon intermittent spot checks of their patients – As Mr. Wong writes, “For patients receiving opioids, intermittent “spot checks” to determine key physiologic metrics are not sufficient in isolation. We strongly recommend the use of continuous electronic monitoring using pulse oximetry and capnography for all patients receiving opioids.”
  • Using checklists to ensure essential safety steps are taken – As Mr Wong writes about the PCA Safety Checklist, as an example of a checklist that can be used: “The PCA Safety Checklist released by PPAHS and developed by a panel of renowned medical experts provides recommended steps that nurses should take on initiating PCA with patients and continuing PCA administration. The expert panel included intensive care specialist and a leader in medical checklist development Peter J. Pronovost, MD, PhD, FCCM, Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine and Medical Director, Center for Innovation in Quality Patient; and Atul Gawande, MD, Professor in the Department of Health Policy and Management at the Harvard School of Public Health, who is a surgeon at Brigham and Women’s Hospital Professor of Surgery at Harvard Medical School and author of “The Checklist Manifesto.”

To learn more about in-hospital opioid safety, please visit PPAHS here.

(2) Harm Reduction Principles

Mr. Wong writes that clinicians are in a unique position to use harm reduction practices, citing resources developed by the Canadian Nurses Association, “Although the results of the extensive research on harm reduction are still mixed, in certain areas the benefits of harm reduction programs are significant. An overview of these benefits can be found in CNA’s discussion paper, Harm Reduction and Currently Illegal Drugs: Implications for Nursing Policy, Practice, Education and Research, which focuses on the following strategies that nurses can take for their patients: needle distribution and recovery programs, peer-based outreach strategies, overdose prevention strategies, methadone maintenance and heroin prescription, supervised injection sites and safer crack use.”

To learn more about how you or your hospital can employ harm reduction strategies, please visit the Canadian Nurses Association here.

To read the article which published on Hospital News, please click here.

 

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