Implementing Arizona Opioid Prescribing Guidelines in Nursing Practice.
The opioid crisis continues to be a significant public health concern, necessitating careful adherence to prescribing guidelines. This paper explores the implementation of the 2018 Arizona Opioid Prescribing Guidelines in nursing practice, focusing on acute and chronic pain management, practical implementation strategies, and insights from a pharmacist interview.
Part One: Incorporating Prescribing Guidelines for Acute and Chronic Pain
The 2018 Arizona Opioid Prescribing Guidelines offer a framework for responsible opioid prescription. A crucial distinction lies in managing acute versus chronic pain. For acute pain, the guidelines emphasize short-term opioid use, focusing on the lowest effective dose for the shortest duration necessary. Consider a patient presenting to the emergency department with a fractured ankle. Following the guidelines, a short course of opioids, such as hydrocodone-acetaminophen, might be prescribed for a few days, alongside non-opioid analgesics and RICE (rest, ice, compression, elevation) therapy (Arizona Department of Health Services, 2018).
In contrast, chronic pain management prioritizes non-pharmacological therapies like physical therapy, cognitive behavioral therapy, and alternative medicine. Opioids are reserved for cases where these prove insufficient and are prescribed at the lowest effective dose. Imagine a patient with chronic back pain. The guidelines suggest exploring non-opioid options first, such as exercise, physical therapy, and mindfulness techniques. If opioids are necessary, they should be started at a low dose and titrated cautiously, with regular monitoring for efficacy and adverse effects (Dowell et al., 2016).
Part Two: Implementing Guidelines in Clinical Practice
Integrating these guidelines into clinical flow involves several key steps. First, thorough patient evaluation is essential, including a comprehensive pain assessment and screening for opioid use disorder. For “inherited patients” already on opioid therapy, careful review of their current regimen is necessary, potentially involving opioid tapering or switching to alternative strategies. Consider a patient with chronic pain transferred from another provider. Reviewing their opioid history, assessing their current pain levels, and discussing potential risks and benefits of continuing or modifying their opioid regimen is crucial (Chou et al., 2020).
Connecting patients with medication-assisted treatment (MAT) is vital for those with opioid use disorder. MAT combines medications like buprenorphine or naltrexone with counseling and behavioral therapies to address addiction. Furthermore, developing an opioid exit strategy is important for patients on long-term opioid therapy. This involves gradual tapering of opioids, combined with increased focus on non-pharmacological pain management strategies. Managing pain and opioids in special populations, such as pregnant women or elderly patients, requires careful consideration of potential risks and benefits (Kolodny et al., 2015).
Part Three: Insights from a Pharmacist Interview
An interview with an outpatient pharmacist provided valuable insights into opioid prescribing practices. The pharmacist emphasized the importance of including all key elements in prescriptions for scheduled medications, such as patient name, date, medication name, strength, dosage form, quantity, directions for use, and prescriber information. They highlighted the stricter regulations surrounding Schedule II drugs compared to Schedules III-V, due to their higher potential for abuse. The pharmacist noted common issues with problematic opioid prescriptions, such as overly high doses, prolonged durations, and lack of clear instructions. They frequently contact providers to clarify these issues, ensuring patient safety and regulatory compliance.
Barriers to patients receiving opioid prescriptions include insurance prior authorization requirements, limited pharmacy access, and patient transportation challenges. The pharmacist suggested improving the opioid prescription process through enhanced communication between providers, pharmacists, and patients, utilizing electronic prescribing systems, and promoting prescription monitoring programs (PMPs). PMPs track opioid prescriptions, allowing providers and pharmacists to identify potential misuse or diversion. The pharmacist explained that the PMP includes information on the patient’s opioid prescription history, including the milligram morphine equivalent (MME), which helps assess the patient’s overall opioid exposure (Federation of State Medical Boards of the United States, 2018).
Conclusion
Implementing the Arizona Opioid Prescribing Guidelines requires a multifaceted approach, involving careful patient assessment, individualized treatment plans, and interprofessional collaboration. By adhering to these guidelines and working closely with pharmacists and other healthcare professionals, nurses can contribute to responsible opioid prescribing practices and mitigate the risks associated with opioid use.
References
Arizona Department of Health Services. (2018). 2018 Arizona opioid prescribing guidelines.
Chou, R., Deyo, R. A., Friedly, J., Skelly, A. C., Hashimoto, R., Weimer, M., … & American Pain Society. (2020). Opioids for chronic back pain: A systematic review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 172(7), 492-504.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recommendations and reports, 65(1), 1-49.
Federation of State Medical Boards of the United States. (2018). Guidelines for the chronic opioid therapy.
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health, 36, 559-574.
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NUR 635 Assessment Description.
The purpose of this assignment is to apply opiate prescribing guidelines in individual nursing practice. You are required to interview a pharmacist to complete Part Three of this paper. Write a 1,500-2,000-word paper that addresses the following:
Part One
Using the “2018 Arizona Opioid Prescribing Guidelines” in the topic Resources, describe how you would incorporate the prescription guidelines into your practice when caring for patients, communities, and populations. In your description provide a patient scenario for the following:
Summary Guidelines for the treatment of acute pain versus chronic pain
Elaborated Guidelines for the treatment of acute pain and chronic pain
Part Two
Review the “How to Implement These Guidelines Into Clinical Flow” section of the “2018 Arizona Opioid Prescribing Guidelines” in the topic Resources. Describe how you would implement the guidelines into your clinical practice, and provide a patient scenario that addresses the following:
Implement these guidelines into clinical flow.
Manage an “inherited patient” on opioid therapy.
Evaluate patients for opioid disorder.
Connect patients with medication-assisted treatment.
Approach an opioid exit strategy.
Manage pain and opioids in special populations.
Connect with local and national resources.
Correct clinical misperceptions about opioids.
Part Three
Interview an outpatient pharmacist. If possible, shadow the pharmacist. Discuss the following in your interview:
What key elements must be included in a prescription for scheduled medications?
Do you treat Scheduled II in the manner as Scheduled III-V? What is the difference between Scheduled II-V drugs?
What are the main issues you see with problematic opioid prescriptions that could have been prevented by the prescriber? What issues do you find yourself calling the provider for?
What are the barriers or issues that would prevent a patient from receiving their opioid prescription?
In your opinion, how would we improve the opioid prescription process between the provider, pharmacy, and patient?
How does a pharmacist incorporate a prescription monitoring program (PMP) in their daily practice?
Describe the components of the PMP including milligram morphine equivalent (MME).
You are required to cite three to five sources related to interprofessional collaboration to complete this assignment. Sources must be published within the past 5 years and appropriate for the assignment criteria and nursing content.
Prepare this paper according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Review the NUR 635 rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
