In recent years, U.S. emergency departments have prescribed fewer opioids for pain patients.
In 2005, providers prescribed opioids in 37.4% of U.S. ED visits by pain patients. The percentage rose to 43.1% in 2010, then fell to a considerably lower 30.9% in 2017, according to the CDC’s January 17, 2020 Morbidity and Mortality Weekly Report.
Yet some worry the pendulum might have swung too far, marginalizing and stigmatizing pain patients who legitimately benefit from the drugs.
Healthcare providers’ biases, as well as pressures to find alternatives to opioids, could diminish quality of care if not kept in check.
Opioid addiction is real
Deaths from drug overdoses, including illicit and prescribed opioids, have steadily risen from 16,849 in 1999 to 70,237 in 2017, according to the National Institute on Drug Abuse. Drilling down to deaths from “any opioid,” mortality was at an all-time high in 2017, the last year of the statistics, when there were 47,600 deaths from opioids.
Death from prescription opioids, including methadone, climbed from 3,442 in 1999 to 17,029 in 2017, remaining stable in 2016 and 2017. In contrast, overdoses involving heroin claimed 15,482 lives in 2017, according to the National Institute on Drug Abuse.
Mike Hastings, RN
ED nurses grapple with the opioid crisis daily. Determining who really needs opioids is especially important given state rules and regulations aimed at limiting the narcotics, or opioids, ED providers can prescribe, said Mike Hastings, MSN, RN, CEN, 2020 president of the Emergency Nurses Association.
“We have patients that come into our emergency departments that are truly in acute pain and truly need pain medication to treat whatever is going on with them,” said Hastings, clinical manager the emergency department at Swedish Edmonds Hospital, Edmonds, Wash.
It’s also no secret people who have abused opioids and try to feed their addictions via the ED.
“That’s where the struggle comes in,” Hastings said. “This is something that we all face. It doesn’t matter if you’re working in a small emergency department in a rural area or work at a big urban trauma center.
Careful not to label pain patients
Labeling ED pain patients as drug seekers isn’t a new thing, but it’s problematic, according to Cathlyn Robinson, MSN, RN, CEN, emergency department clinical education specialist, St. Joseph’s Health.
“One of the predominant reasons patients seek care in the emergency setting is because they’re having pain,” she said. “It’s a very legitimate and real reason to come see us. There’s no question.”
To better understand which patients should and shouldn’t receive narcotic pain medications, ED nurses need to put aside judgments and biases. They should listen and treat each patient holistically, according to Hastings.
“From a nursing standpoint, we really do have to make sure we are not becoming biased. It can be extremely difficult to do,” Hastings said.
By conducting a full assessment and asking about potential injuries, type of employment, medical history, prior pain treatments and more, nurses better understand the root cause of what’s going on with …read more
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