Posted: October 2nd, 2024

Integrating Opioid Prescribing Guidelines into Nursing Practice Essay

Integrating Opioid Prescribing Guidelines into Nursing Practice

The opioid crisis has necessitated stringent guidelines for prescribing opioids to ensure patient safety and effective pain management. The “2018 Arizona Opioid Prescribing Guidelines” provide a framework for healthcare professionals to manage opioid prescriptions responsibly. This paper explores how these guidelines can be integrated into nursing practice, focusing on acute and chronic pain management, clinical implementation, and interprofessional collaboration with pharmacists.

Part One: Incorporating Guidelines into Practice
Acute vs. Chronic Pain Management
The guidelines differentiate between acute and chronic pain management. Acute pain, often resulting from injury or surgery, requires short-term opioid use. For instance, a patient with a fractured arm might receive a limited opioid prescription, emphasizing non-opioid alternatives and a clear tapering plan (Arizona Department of Health Services, 2018).

Chronic pain, such as that from arthritis, necessitates a comprehensive approach. Opioids should be a last resort, with a focus on multimodal therapies including physical therapy and cognitive-behavioral strategies. Regular reassessment and monitoring for signs of opioid use disorder are crucial (Dowell et al., 2016).

Patient Scenario
Consider a patient with post-operative pain from knee surgery. Initially, opioids are prescribed for severe pain, with a plan to transition to NSAIDs and physical therapy within a week. For a patient with chronic back pain, opioids are considered only after exploring physical therapy, acupuncture, and non-opioid medications, with regular evaluations to prevent dependency.

Part Two: Implementing Guidelines into Clinical Practice
Clinical Flow Integration
Implementing these guidelines requires a structured clinical flow. This includes initial patient assessment, risk evaluation, and ongoing monitoring. For example, a patient with chronic pain is assessed for opioid therapy suitability, considering their medical history and potential for substance use disorder (Arizona Department of Health Services, 2018).

Managing Inherited Patients
Inherited patients on long-term opioid therapy pose unique challenges. A comprehensive review of their treatment history and current condition is essential. Adjustments to their regimen should be made cautiously, with a focus on reducing opioid use while managing pain effectively (Chou et al., 2019).

Evaluating for Opioid Use Disorder
Regular evaluation for opioid use disorder involves screening tools and patient interviews. If a disorder is suspected, referral to a specialist and consideration of medication-assisted treatment (MAT) are necessary steps (Substance Abuse and Mental Health Services Administration, 2020).

Opioid Exit Strategy
Developing an opioid exit strategy involves tapering the dose gradually while introducing alternative pain management techniques. This approach minimizes withdrawal symptoms and supports long-term recovery (Busse et al., 2017).

Special Populations and Resources
Special populations, such as the elderly or those with comorbidities, require tailored approaches. Connecting with local and national resources, such as pain management clinics and support groups, enhances patient care. Correcting clinical misperceptions about opioids through education is also vital.

Part Three: Pharmacist Interview Insights
Key Elements of Prescriptions
A prescription for scheduled medications must include patient information, dosage, and specific instructions. Schedule II drugs, such as oxycodone, require stricter controls compared to Schedule III-V drugs, which have lower abuse potential (Drug Enforcement Administration, 2021).

Common Prescription Issues
Pharmacists often encounter issues like incomplete prescriptions or potential drug interactions. These could be mitigated by thorough patient evaluations and clear communication between prescribers and pharmacists.

Barriers to Receiving Prescriptions
Barriers include insurance issues, pharmacy stock shortages, and regulatory restrictions. Improving communication and streamlining processes between providers, pharmacies, and patients can alleviate these challenges.

Prescription Monitoring Programs
Pharmacists use Prescription Monitoring Programs (PMPs) to track opioid prescriptions and identify potential misuse. The PMP includes components like the milligram morphine equivalent (MME), which helps assess the total opioid burden on a patient (Arizona Department of Health Services, 2018).

Conclusion
Integrating the “2018 Arizona Opioid Prescribing Guidelines” into nursing practice involves a multifaceted approach to pain management, patient evaluation, and interprofessional collaboration. By adhering to these guidelines, healthcare professionals can enhance patient safety and contribute to mitigating the opioid crisis.

References
Arizona Department of Health Services. (2018). Arizona Opioid Prescribing Guidelines. Retrieved from [link]

Busse, J. W., et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ, 189(18), E659-E666.

Chou, R., et al. (2019). Management of suspected opioid overdose with naloxone in out-of-hospital settings: A systematic review. Annals of Internal Medicine, 170(12), 891-902.

Dowell, D., et al. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624-1645.

Substance Abuse and Mental Health Services Administration. (2020). Medication-Assisted Treatment (MAT). Retrieved from [link]

Drug Enforcement Administration. (2021). Drug Scheduling. Retrieved from [link]

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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.

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Tags: Clinical Guidelines, NUR 635, Nursing Assessment, Opioid Prescribing, Pain Management