According to the Centers for Disease Control and Prevention, more Americans are likely to die each year from a drug overdose than from traffic accidents. And opioids account for more than three out of five overdose deaths. These scary statistics prompted me to initiate a discussion with MEDITECH’s Nurse Advisory Committee, comprised of 16 clinicians from different specialities throughout the US. From their collective experience, we came up with several ways that nurses and other providers can use their electronic health records to help patients manage pain, without falling into addictive drug use patterns. Here’s our top five:
1. Document and manage inpatient discomfort using pain assessments.
Nurses can better understand a patient's pain tolerance by using assessments to monitor severity. After documenting the patient’s pain scale in the EHR and learning about effective measures they have previously used to manage pain, we can then take steps to educate the patient on when it’s appropriate to take a narcotic instead of acetaminophen or ibuprofen. After administering a pain medication, nurses can monitor its effectiveness using the EHR to automatically schedule pain reassessments.
2. Identify the most effective pain management alternatives.
Using pharmacogenomics as part of a clinical decision support strategy, clinicians can offer pain relief tailored to the patient’s individual needs--which contributes to a quicker recovery while avoiding prolonged use of multiple narcotics. For example, by mapping DNA before surgery, we can determine the best post-operative pain medications for that particular patient. Clinical decision support can also alert providers if they select a pain medication deemed ineffective based on the patient’s DNA profile.
3. Customize order sets for pain management.
Nurses may use pain scale assessments, interventions, and notes to develop an appropriate pain management plan with medication and dosage recommendations, as well as options for multimodal treatments for pain. Embedding this information within order sets helps us to set optimal dosing and minimizes the risk of relapse when patients are “narcotic naive” or become acclimated to pain medication. Order sets with tapered dosing and alternative suggestions to narcotics can also support patients recovering from substance abuse who are admitted to the hospital for a serious illness, injury, or surgery.
4. Educate patients across care settings.
Many physician practices are now employing case managers to have discussions with patients about safe pain management options and the dangers of overusing or misusing opioids. Within surgical and inpatient locations, all patients should receive counseling regarding symptoms of narcotic withdrawal. Putting this information in discharge instructions has also been shown to improve outcomes over using generic, canned responses such as ‘Take prescribed medication to keep your pain level under control.’
5. Implement Nurse Navigator Programs to limit narcotic ordering in the ED.
Having a nurse navigator on your ED staff can help repeat visitors seeking relief from chronic pain syndromes--by identifying a patient’s true needs, ruling out other issues, and offering non-medication alternatives such as relaxation techniques. Implementing this program in addition to using a fully integrated EHR helps bridge communication gaps between care settings and expose potential addiction warning signs.
The problem of opioid misuse is a complex one, and requires collaboration among all clinicians to work through viable solutions. With teamwork and integrated technologies on our side, we can help patients struggling with chronic pain, and get them on a path to better health.
Read our case study for a closer look at how an ED Nurse Navigator Program resulted in $475,000 annual savings for Avera McKennan.