Best Practice

Recommendations for
Prescription Opioid
Education

Olivia Mills
Chapter 1: Purpose
● Purpose: to describe the current best practice recommendations for
prescribing opioids for pain management and how to educate patients on safe
use
● Research shows there is a lack of knowledge among healthcare professionals
and patients regarding safe prescription opioid use
● Significance in nursing
○ Nurses have a vital role in educating and advocating for their patients
○ Nurses assess patients for pain and decide which intervention to implement which can influence
whether or not a patient gets opioid pain medication
Chapter 1: Background of Issue Importance
● In the 1990s pharmaceutical companies assured patients and the medical
community that short-term use of opioids were not addictive, which led to a
dramatic increase in the amount of opioids prescribed due to the high success
rate of pain management
● This led to the opioid crisis in the US
● Lack of sufficient discharge education for patients on how to safely use, store
and dispose of
● Education can be a significant factor in preventing opioid abuse
Chapter 1: Expert Opinion
● CDC
○ Systematic review of 12 guidelines for prescribing opioids for chronic pain
○ Guidelines for prescribers on how and when to prescribe opioids
● Arizona Opioid Prescribing Guidelines
○ Recommended to be used by healthcare providers for treating patients with acute and chronic
pain
○ These guidelines are organized by acute pain, chronic pain and risk mitigation and then
recommendations on how to implement these recommendations into practice, how to identify
at-risk patients, and other recommendations related to prescription opioid use
○ Aimed at healthcare providers as guidelines for prescribing opioids
● Arizona Pain and Addiction Curriculum
○ Aimed to redefine pain and addiction with a more holistic view including a neurobiological,
clinical, psychological, cultural, and cognitive approach
○ Targeted at pre-graduated health care professionals so that they implement these guidelines
into their practice
Chapter 2: Provider Education
● Opioid Prescribing Education in Surgical Residencies
○ It is the duty of healthcare professionals to educate patients
○ Providers must be adequately educated as well
○ Findings: out of 110 surgical residency programs, 104 of the programs allow residents to
prescribe opioids but very few require opioid prescribing education for their patients
● Preventing Opioid Misuse and Potential Abuse
○ Nurses must have adequate knowledge to be able to properly educate their patients
○ Findings: significant lack of knowledge among nurses to provide proper discharge teaching to
patients regarding prescription opioids
● Effectiveness and Risk of Long-Term Opioid Use for Chronic Pain
○ Systematic review on benefit versus risk of long-term opioid therapy used for chronic pain
○ Findings: greater the opioid use, the greater the risk for overdose and long-term opioid therapy
is correlated with increased risk for abuse and dependence
Chapter 2: Patient Education
● Development and Validation of the Patient Opioid Education Measure
○ This tool (POEM) was developed to identify the lack of knowledge among patients regarding
opioid use
○ Findings: this tool was successful at identifying patients who are at-risk for having inadequate
knowledge about prescription opioid use and to establish what needs to be clarified in the
teaching
● Implementation of Opioid Overdose Education
○ Opioid overdose educations and naloxone distribution (OEND) was implemented to the public
(intervention and control group)
○ Findings: when the OEND was implemented, there were significantly reduced rates of opioid
overdose deaths compared to when it was not implemented
● Improving Education Provided by Nurses to ED Patients
○ Emphasis on evidence-based education provided by nurses to patients in the ED using a
teach-back method
○ Findings: support the use of patient education in the ED using the teach back method
Chapter 3: Guidelines for prescription opioid pain
management and education
● Education for healthcare professionals on the effects of opioid use
○ Implement curriculum within pre-graduated healthcare professional education
● Education for the patient on the dangers of opioid use
● Reduce the quantity of opioids prescribed and administered
● Reduce the dosage of opioids prescribed and administered
● Using non-opioid treatments as first-line for pain management
○ Use a least invasive to most invasive approach
● Identify patients who are more at risk for opioid use disorder and recommend
them to resources and further teaching
● Redefine pain and addiction as neurobiological, clinical, psychological, cultural,
and cognitive
Chapter 4: Implementation and Evaluation
● Evidence within this thesis suggests that there needs to be curriculum within
pre-graduated healthcare professionals’ education
● Proposal for implementing prescription opioid education within the curriculum
of the BSN program at the U of A
● Curriculum based off of the most current evidence-based recommendations for
prescription opioid use, administration and education as well as expert opinion
● The curriculum would be implemented across all four of the BSN semesters and
align with the lesson plans for each semester
First Semester
● Implement more teaching into pathophysiology and pharmacology
● Pathophysiology: teach more about addiction, tolerance and how opioids act in
the body
● Pharmacology: more teaching on different strengths of opioids and other
non-opioid pain medications
● Encourage a consistent use of the 0-10 pain scale and how to treat different
pain levels
● SILC lab simulation: head-to-toe assessment with an acute pain score greater
than 0
○ Student would have to decide how to treat the pain from least invasive to more invasive
Second Semester
● In this semester, students learn how to administer medications
● Proposed curriculum: more in-depth pain assessment, safe choice and
administration of pain intervention and reassessment of the pain once the
medication has taken effect
● SILC lab simulation: patient with chronic cancer pain
○ Student would be expected to treat the pain and how they would reassess the effectiveness of
the intervention
○ The student would also be expected to educate the patient on how to manage chronic pain
through integrative therapies and self-management
Third Semester
● This semester the proposed curriculum would emphasize discharge education
● Proposed curriculum: students would be required to provide discharge
teaching that includes evidence-based recommendations on opioid education
○ Students should be tested on their knowledge of the dangers and side effects of opioids, proper
storage and disposal
● SILC lab simulation: patient with chronic back pain who is currently on chronic
opioids
○ Student is expected to begin with an evidence-based tool such as the Patient Opioid Education
Measurement (POEM) to screen at-risk patients for their level of knowledge regarding opioids
○ Student would take these findings and decide how to educate the patient with resources to treat
opioid use disorder and the dangers of chronic opioid use
Fourth Semester
● By now, students are expected to be competent in their patient skills and now
focus on leadership, management, and delegation
● Proposed curriculum: implement teaching on how to prioritize patients’ needs
including their pain needs and interventions related to pain
○ Also teaching on decreasing stigma against patients with opioid use disorder and how nurses
must try to help these patients
● Instead of SILC lab, this semester would have a written exam based on patient
prioritization, delegation and reducing stigma
○ The student would provide discharge education within the written assignment based on
different patient scenarios
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