A few minutes after administering a dose of oral opioid pain medications to a 27 year old patient, I came back to the room to check in on him. Finishing my round, I went inside his bathroom and found a paper with what was clearly crushed meds, and a syringe neatly stored on the floor behind the trash can. I immediately confronted the patient who instinctly denied any knowledge of the paraphernalia inside his room's bathroom. He was a young kid, well my age, but young compared to the patients I'm accustomed to treating, getting long term antibiotics for osteomyelitis in the foot.
I can imagine how much it hurts, so by no means would I deprive him of pain medications. I decided to start crushing his medications and mixing it with applesauce, after letting the physicians and management know.
Next day I came back and was assigned the same patient. I was told by the night shift nurse that his PICC line was sluggish to flush and looked infected, some cloudy stuff came off when she drew the morning labs from the PICC. The PICC team was notified, and to all of our surprise, the cloudy stuff? Applesauce.
He had managed to fish out another syringe from the sharps container, pocketed the applesauce with the crushed meds, and attempted to inject it. I was impressed with the degree of his addiction to the opioids, that he would literally inject applesauce to try to get the high. He clearly had pain, and as a nurse I wanted to keep him comfortable; but I wanted to make him comfortable, not high.
So, how can nurses help fight the opioid crisis at the bedside? I have seen patients nearly kill themselves in the streets, just to have a reason to come into the hospital and get an opioid fix. We can educate, tell patients all we know about the dangers of drug abuse, attempt all non-pharmaceutical approaches, but our patients will holler and ask for the intravenous push. We have grown resistant to warm or cold compresses, resistant to extremity elevation, and other nursing interventions.
Do we have the power to advocate for our patients and work with physicians to prescribe less aggressive meds first, and try to control the pain with a tramadol perhaps; yes, I understand there may be some people that may have some allergies to other medications. Can we nurses and physicians attempt that approach or our HCAHPS more valuable?
Have we really raised a culture of opioid addiction in our hospitals? Has the white boards influenced patients to believe that PRN medications are no longer as needed, and are now assumed to be scheduled based on the times we write down? How big was the nurse's role and influence in the national opioid epidemic?
The American Nurses Association has formally recognized opioid addiction as a significant public health crisis, in a statement on their website it addresses opioid crisis by stating, “As healthcare providers practicing on the front lines of the opioid epidemic, registered nurses are qualified and well positioned to play a leading role in assessing, diagnosing, and managing patients battling addiction.”
Nurses, as advocates, will need to stand up for their patients by recognizing both insufficient pain management or excess pain management. Also, nurse leaders will need to assess and implement hospital protocols to aid in the weaning off of opioids process prior to patients being discharged, to also aid in the prevention of withdrawal symptoms.
The ANA also states that, "issues surrounding abuse and misuse of prescription opioids must be balanced with the real and legitimate needs of those seeking treatment for pain. ”There has been much attention being brought on physicians over-prescribing, but there still little defined as what the nurse's specific roles are in the fight against opioid abuse, but education and raising awareness is our main tool at this time
The Dude Nurse
Klaus Campos, BSN-RN