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Oct. 18, 2019

Providing safe and effective pain control in the era of opioid misuse

If you search ‘opioid crisis’ in Google news, you will find over 13 million results. It should come as no surprise to learn that Canada is in the midst of an opioid epidemic. Over the past 10 years, there has been an unprecedented increase in overdoses and deaths associated with the use of opioid pain relievers. This has caused the medical community to examine opioid prescribing practices.

Although opioids are the cornerstone of acute pain management, they are highly addictive, must be carefully managed, and are not always the right choice for everyone. In 2017, new Canadian guidelines for opioids for non-cancer pain were released to help reduce the overprescribing of opioids.

At the same time that these guidelines were being written, nurse practitioners (NPs) were granted the authority to prescribe controlled substances. Nurse practitioners are highly educated and experienced nurses who are able to diagnose illnesses and prescribe medications. Before this change in their role, NPs were able to prescribe a number of different medications, but this did not include opioids. Now, after completing the education requirements, it is part of their role to carefully and safely prescribe opioids to patients.

“Our NP colleagues advised us they required ongoing education for continued competence and confidence in opioid prescribing, as well as for sustainability of this extended scope of practice,” said Kathy Popovski, an NP on the acute pain service at St. Michael’s Hospital.

NPs Kathy Popovski and Elizabeth Logan heard the need from their colleagues and took on this challenge.

“As experts in pain management, we have the knowledge and expertise in non-pharmacological and pharmacological pain management strategies, including opioid therapy,” Popovski said. “As opioids remain the cornerstone of managing acute pain, our extensive experience with opioid therapy provided the perfect fit to lead the educational initiatives to support safe and effective prescribing of controlled drugs and substances for NPs at St Michaels.”

They started by sending out a survey to their colleagues to assess their educational needs. Based on the responses, they developed a number of resources and workshops to support safe and effective prescribing of controlled drugs and substances.

These initiatives included:

1. Hosting an educational lecture series on the guidelines for prescribing
2. Providing a consultation service
3. Creating discharge instructions to provide education and instructions for patients

Popovski and Logan are currently evaluating the effectiveness of these initiatives for supporting NP learning and following up with their NP colleagues to determine future educational needs. This training is offered to NP students throughout all their rotations, and has been a very successful and well received initiative.

Nurse Practitioners like Popovski and Logan use experiential and scientific knowledge to provide comprehensive pain management to patients. This includes opioid dose reduction, providing alternative therapeutic options, patient education, and follow up. Nurse practitioners at St. Michael’s are in a unique position to provide leadership in providing safe and effective pain control in the era of opioid misuse.

Connecting with IPBR

The Interprofessional Practice Based Research program (IPBR) at St. Michael’s Hospital assists nurses and health disciplines professionals engage in the identification, implementation, and evaluation of best practices through research. Popovski and Logan have had consultations with the IPBR team to refine their research questions and develop knowledge translation tools to share their educational resources. Their work has been published in Canadian Nurse.



Read more IPBR blog entries