Emergency departments have been, and always will be, on the front lines of pain relief. If a patient arrives at triage suffering from chronic or acute pain, it’s the responsibility of the emergency department (ED) and its staff to do all they can to alleviate that pain and strive to provide patient satisfaction.
Now, as over 40 percent of ED visits in the United States are in response to pain, and as an opioid epidemic plagues communities across the nation and is making headlines, EDs have to be extra vigilant when it comes to managing that pain.
Rachael Gordon, BSN, RN an emergency nurse at Natividad Medical Center in Salinas, Calif. knows firsthand the difficulties EDs face when it comes to battling the opioid epidemic. Gordon previously worked at an ED in Oregon, where she was instrumental in implementing a program in response to the rising rates of opioid dependence.
This week we’ll look at four tactics EDs can integrate into their treatment processes that will help staff address many issues stemming from the opioid epidemic. These strategies, based on Gordon’s experience in Oregon, have far-reaching potential for EDs everywhere in the country.
1. Don’t discharge patients with more than three days’ supply of opioids.
Emergency department staff are not responsible for the long-term management of patients’ pain. It is important to acknowledge that patients may have difficulty making an appointment with their primary care physician (PCP) — or, in some cases, may not even have a PCP — but prescribing more painkillers than is absolutely necessary increases the likelihood a patient will develop a dependency on the drugs.
2. Do not fill.
In some instances, specifically for persistent, non-cancer pain patients, ED staff must make the difficult decision of not prescribing a narcotic painkiller. Though patients may continue to experience discomfort, there are a variety of alternatives ED staff can offer, such as hydrazine, clonidine and Zofran, that patients can take until they are able to see their PCP.
3. Check your state’s PDMP and train staff on how to properly utilize it.
Prescription Drug Monitoring Programs are an important tool when it comes to identifying patients who may be at high risk of developing an opioid dependency. These state-run databases allow providers to access the prescription drug history of a patient and provide the critical information necessary to determine whether or not the patient would benefit from an early intervention.
4. Be compassionate.
If patients are exhibiting signs of a prescription drug dependency act with compassion. Just like their pain, their dependency is a chronic condition — one ultimately created by healthcare providers and one that has, unfortunately, yet to be addressed. These patients need continued care, and many times the first step to treatment and overcoming a dependency begins within the ED.
Next week, we’ll explore four more steps EDs can take to address the challenges brought forth by the opioid epidemic. In the meantime, if you’re interested in learning more about what strategies EDs can implement to battle this crisis, feel free to drop me a line.
American College of Emergency Physicians: “Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department (June 2012).”
Rachael Gordon, BSN, RN an emergency nurse at Natividad Medical Center in Salinas, Calif.