Only the IV Dilaudid works for me

Abstract

Hospitalized patients have come to rely on the immediate pain relief afforded by intravenous (IV) opioids. Often appropriate upon admission, as needed, prolonged IV opioid orders remain active even after the patient's conditions improves. If prn opioids are ordered and the patient asks for the IV opioid, the RN feels obligated to administer the medication. Recent medical guidelines urged hospitalists to adhere to prescribing strategies that favor the oral route when the patient does not have gastrointestinal dysfunction. Prolonged IV opioid use, when other routes are available, can carry significant risks. These risks include more side effects, medication errors, and potential downstream improper opioid use post hospitalization. In addition, opioids administered intravenously, rapidly reach the reward and euphoria brain centers. This produces reinforcement in patients. Reinforcement is escalated when repeated doses of IV opioids are administered; this may lead to habitual and eventual problematic opioid use post hospitalization. The Acute Pain Service (APS)is an interdisciplinary nursing/pharmacy team at a 901-bed hospital in Sarasota, Florida. Using descriptive statistics, the team examined the medical records of one hundred patients after an electronic alert fired. The alert signaled that the patient had received twelve doses of IV opioid during his hospitalization. We questioned whether APS recommendations would ultimately change prolonged opioid orders. Of the one hundred patients studied, physicians accepted 45% of the APS recommendations. Many physicians were unaware that their patients were continuing to receive IV opioids. Prolonged IV opioid orders were deemed appropriate (55%) in hospice situations, short time IV opioid use situations and in those patients who were discharged shortly after the alert fired. Given the national emphasis on curbing prescription opioid use, this presentation has implications for acute care nurses. Learn how the APS manages the alert using a critical thinking algorithm including approaching both patients and physicians. Concepts discussed will enable nurses to deliver safe analgesic care.