Publish Date: December 20, 2017
In the national movement to fight opioid abuse, perioperative nurses find themselves front and center as many opioids provided to postoperative patients are diverted. And yet, perioperative nurses may feel powerless to act when it’s the physicians prescribing these pain medications.
Not so, according to Melanie Simpson, PhD, RN-BC, OCN, CHPN, CPE, a nurse who leads the pain management team for the University of Kansas Health System in Kansas City, Kan.
She consults with nurses and physicians to address postoperative pain options with an emphasis on multimodal analgesia, such as ice, anti-anxiety alternatives such as music and aromatherapy, and non-opioid medication options.
“Opioids should be a last resort and administered judiciously. Unfortunately, this is not always the case,” Simpson acknowledges.
“Perioperative nurses should feel extremely empowered to do their part in turning the tide of opioid abuse because patients trust us and we have the knowledge and competence to help them manage their pain in so many different ways,” Simpson stresses. For severe pain, she says blocks provided by an anesthesia provider can also offer a non-opioid option.
“Turning to opioids has become a knee-jerk reaction when a patient reports pain, yet an option as simple as ice can provides faster relief than it takes for an administered opioid to take effect,” she shares.
While Simpson says many physicians are addressing non-opioid options, it has often become habit for many physicians to order and administer opioids preoperatively to address potential pain, but this is not always the best approach for a patient’s optimal outcome—which perioperative nurses know as they support patients with opioids in their system who experience postoperative nausea and difficulty ambulating.
“The number one thing we can do for pain is educate patients before they are in pain to establish a plan for multimodal analgesic options and non-pharmacologic strategies,” Simpson says. Her pain management team members meet with patients preoperatively to provide a comfort menu of non-opioid pain management options, such as listening to music or comforting sounds or having nurse place lavender under their pillow. Choosing such options can empower the patient in managing their pain at the hospital and at home.
A similar approach with preoperative planning and a pain management comfort menu is offered within a Midwestern health system where AORN Perioperative Practice Specialist Erin Kyle, DNP, RN, CNOR, NEA-BC, recently left her role as regional director.
Within this health system, nurses present themselves to patients as “partners in pain control,” a phrase repeated at every touchpoint in a patient’s care from the earliest stages of preoperative testing to postoperative check-in with a discharged patient, Kyle explains.
Successful results from this work have been realized, she shares, noting that patients reported better pain control and inpatient nurses reported patient satisfaction with the comfort menu; also patients consumed fewer opioids while in the inpatient setting.
Taking Action In the OR
With an increasing number of patients voicing concerns about not being given opioids, and potentially also being part of an enhanced recovery after surgery (ERAS) program, in which opioid avoidance is one element, Simpson says “the preoperative RN has a responsibility to voice this concern with the surgical team and also document it to ensure the patient’s wishes are respected in the OR.”
Simpson also says that as patients’ advocates in the OR, nurses have a responsibility and a right to speak up for the patient to remind other members of the team not to administer opioids and to relay this important information when a patient is transferred to postoperative recovery.
Educating at Postoperative Recovery and Discharge
Postoperative recovery is a critical point for the patient, nurse and physicians to be ready with language and strategies for discussing and managing pain because patients are hurting and want immediate relief, Simpson and Kyle share.
They suggest this dialogue can be scripted to reiterate with patients preoperative pain goals and discuss options from the non-medicine comfort menu. This education should continue as the patient recovers and prepares for discharge.
For patients who are sent home with opioids to manage pain, Simpson stresses the need for taking time to discuss the seriousness of taking home an opioid.
“Patients can be in danger if they are known to be coming home after surgery and possibly have opioids that could be taken by others for nonmedical use,” Simpson stresses. “Patients need to understand that opioids must be managed with care at home by being stored in a controlled way and disposed of safely if there are extras.”
Simpson also says physicians must do their part by sending patients home with a reasonable amount of opioids to reduce the risk for diversion.
Read more from Simpson on multimodal analgesia options for perioperative patients in this Dec. 2016 issue of AORN Journal.
Review AORN’s updated Guideline for Medication Safety in the 2018 edition of Guidelines for Perioperative Practice to understand the evidence for opportunities such as educating patients on medication use.
Learn more about Perioperative Opioids and Public Health in this 2016 issue of Anesthesiology.
Talk to your perioperative teams about the dangers of opioid abuse that can be stemmed in the perioperative setting by establishing these goals, as noted by the US Surgeon General Vivek H. Murthy, M.D., M.B.A at TurntheTideRX.org:
- Educate to treat pain safely and effectively.
- Screen patients for opioid use disorder and provide or connect them with evidence-based treatment.
- Influence how addiction is understood by talking about and treating it as a chronic illness, not a moral failing.