uniting and leading through np education: educating nurse ... · • during the 1980’s and...
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Uniting and Leading through NP Education:Uniting and Leading through NP Education:
Educating Nurse Practitioner Students Across Populations RegardiEducating Nurse Practitioner Students Across Populations Regarding ng
Their Roles in Caring for Clients with Opioid Use Disorder and Their Roles in Caring for Clients with Opioid Use Disorder and
Chronic PainChronic Pain
The International Nurses Society on AddictionsThe International Nurses Society on Addictions
4141stst Annual ConferenceAnnual Conference
October 19, 2017October 19, 2017
Dana Murphy-Parker, MS, CRNP, PMHNP-BC, CARN-AP, FIAAN
Jennifer Coates, MSN, MBA, ACNP-BC, ACNPC
Brenda Douglass, DNP, APRN, FNP-C, CDE, CTTS
Heather Frye, APRN, PMHNP-BC, MSN, MBA
Susan Solecki, DrPH, FNP-BC, PPCNP-BC
Jill M. Terrien, PhD, ANP-BC
The International Nurses Society on Addictions
Mission StatementMission Statement
• To advance excellence in nursing
care for the prevention and
treatment of addictions for diverse
populations across all practice
settings through advocacy,
collaboration, education, research
and policy development.
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https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/presidential-memorandum-addressing-prescription-drug-
abuse-and-heroin
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Presidential Memorandum -- Addressing Prescription Drug Abuse and Heroin Use
White HouseFor Immediate Release: October 21, 2015
• This directive from President Obama, was based on the tragic national epidemic involving prescription opioids and heroin which quadrupled more than 16,000 deaths in the United States between 1999 and 2013. The Memoranda stated that all health professionals who spend 50 percent or more of their clinical time under contract with the Federal Government, and prescribed controlled substances within the terms and conditions of their contract must obtain this training.
• The Presidential Memoranda declared that training must include the following:
● best practices for appropriate, and effective, prescribing of opioid pain medications
● principles of pain management
● proper methods for disposing of controlled substances
● misuse potential of controlled substances
● identification of potential substance use disorders
● referral to further evaluation and treatment
American Association of Colleges of Nursing (AACN)
• AACN Announcement on Initiative on the Opioid Crisis
• http://www.aacn.nche.edu/opioids
• AACN Opioid Crisis Webinars
• file:///C:/Users/dam355/Downloads/20170312_00001%20(8).pdf
Commitment from American Association of Colleges of Nursing (AACN) to educate and combat opioid crisis and prescription drug
abuse (April, 2016)
http://www.aacn.nche.edu/news/articles/2016/opioids
"Academic nursing is committed to protecting the public's healthby taking decisive action to address the nation's opioid epidemic," said Dr. Trautman. "I applaud my colleagues in the nursing community who have made it a priority to prepare the next generation of APRNs on best practices for prescribing opioids."
1. Educate APRN’s about opioid crisis.
2. Educate APRN students on the Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for ChronicPain.
Tuesday, October 31, 2017 Drexel University College of Nursing and Health Professions 6
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How did we get here?How did we get here?
• Pain as ‘the 5th vital sign’ contributed to increased prescribing of
opioids for pain, and at the same time increased the availability of
opioids for diversion and misuse of opioids.
• During the 1980’s and 1990’s pain management was equated to
prescribing opioids for pain.
• There is a serious problem of diversion and abuse of opioid drugs.
• 75% of opioid overdoses were people using opioids for non-medical
reasons.
• Treatment dichotomy. Opioids do legitimately relieve pain, and help
those with chronic pain disorders to be more functional; however, at
the same time, there are those who use these substances and it goes
to their reward system, and increases misuse of prescription opioid
medications, and can lead to an Opioid Use Disorder.
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N Engl J Med. 1980, Jan 10 (302)
• Addiction is Rare in Patients Treated with Narcotics
________________________________________________
• The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management.
• Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at best, modest improvements in pain management practices.
• (Berry & Dahl, (2000). The new JCAHO standards: Implications for pain management nurses). Pain Management Nursing, 1 (1), 3-12.
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A decision to advance opioid dosing should not be based A decision to advance opioid dosing should not be based
solely on pain scores, but should include a comprehensive solely on pain scores, but should include a comprehensive
functional assessment (Treisman & Clark, 2011). functional assessment (Treisman & Clark, 2011).
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CDC Guideline for Prescribing Opioids for Chronic PainCDC Guideline for Prescribing Opioids for Chronic Pain——
United States, March 16, 2016United States, March 16, 2016
There are 12 recommendations. Of
primary importance, nonopioid therapy is
preferred for treatment of chronic pain.
Opioids should be used only when
benefits for pain and function are
expected to outweigh risks.
Recommendations from CDC
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A Call for CollaborationA Call for Collaboration
Interdisciplinary Approach
● Pediatric Nurse Practitioner
•Acute Care Nurse Practitioner
•Psychiatric Nurse Practitioner
•Family Nurse Practitioner
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Interdisciplinary Case Discussion
• John Smith is an 18 year old male high school student who presents to the PPCNP office accompanied by his mother. John’s mother is worried
about his alcohol and drug use.
• John required knee surgery 3 months ago impacting his athletic
performance in wrestling and is anxious regarding obtaining an athletic scholarship for college.
• John was ordered oxycodone in the post-op period. After evaluation, his
orthopedic surgeon ordered NSAIDS and physical therapy for rehabilitation however, John states his knee was “never right” after the
surgery.
• John’s mother states that since his surgery, John’s grades have dropped in school although he is a good student, is having mood swings, and has
come home “drunk and appearing high” after partying with friends.
• When interviewed alone, John admits to alcohol and marijuana use. He
states he has also been “borrowing prescription medications” from his friends.
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The Pediatric Opioid Abuse Epidemic • Opioid prescriptions to adolescents and young adults nearly doubled from
1994 to 2007.5
• After marijuana, prescription medications are the drugs most commonly abused by the adolescent population with the biggest growth of abuse among persons aged 12 to 24 years.5
• An estimated 14% of high school seniors have used prescription drugs for non-medical reasons at least once.5
• Female teenagers, in particular, see prescription pills as “cleaner” than other drugs, and equal their male counterparts in prescription drug use, but are less likely to use marijuana or cocaine compared to males.5
• Student athletes may see pills as a way to enhance sports performance or may self-medicate with opiates for pain related to sports injuries. 5
• Seventy percent of all people who abused prescription pain relievers obtained them from friends or relatives, often without permission.9
The Neurobiology of Adolescence and Addiction Vulnerability
• Adolescence is a period of dynamic biologic, It is also a time of enhanced sensitivity to stress. psychological, and behavioral changes.1
It is also a time of enhanced sensitivity to stress.
• Developmental changes in neural circuitry may contribute to vulnerability for increased levels of engagement in substance use and nonsubstance
addictive behaviors.1
Also, because white matter and hippocampal development is still being laid down in teens,
their brains are more susceptible to destructive effects of drugs including impaired pre-fontal cortex function, working memory, and motor coordination.
• The chief predictor of adolescent behavior is not the perception of risk, but
the anticipation of the reward despite the risk.3
Studies suggest that more than 80% of adolescents experiment
with drugs or alcohol before adulthood.2
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Biologic Models of Adolescent Vulnerability
• The midbrain dopaminergic system
A common neural pathway of reward that with repeated drug exposures in susceptible individuals may prime neuro circuits. Over time addictive behaviors may “hijack” the
brain’s natural reward system, making it more responsive to the primary drug of abuse and less responsive to other “natural” reinforcers/rewards.
• Stress-associated neuroplasticity Stressors can turn on genes that can lead to the dysregulation of the HPA. The use of
substances to relieve the stress also dysregulates the HPA axis, leading to a vicious cycle of worsening sensitivity to stress each time substances are used to relieve the
stress.
• Maturational imbalances between cognitive control and reward reactivity
Adolescence is a period where two separate entities are independently working, lack of cognitive control (immature prefrontal cortex) and risk taking (due to earlier
maturation of the nucleus accumbens.
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Adolescents at Risk for Substance Abuse Disorders
•Genetics
•Environmental
•Comorbidities
•Personality
•Age
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Turning The Tide
On August 26, 2016 the U.S. Surgeon General implored clinicians to take a more
active role in stemming the opioid crisis by asking them to sign a 3-pronged online pledge:
1. First, to educate yourself on how to safely and effectively treat pain.
2. Second, to screen your patients for opioid use disorder and provide or connect
them with evidence based treatment.
3. And finally, to discuss and treat opioid addiction as the chronic illness it is—not a moral failing.
These are the children in your waiting room right now (turnthetiderx.org).
“We, as clinicians, are uniquely positioned to turn the tide on the opioid
epidemic.”
- US SURGEON GENERAL
VIVEK MURTHY, MD, MBA
Contemporary Pediatrics, 2016
Signs and Symptoms of Opioid Abuse
• Sudden change in personality without another known cause
• Anhedonia
• Sudden decline in school performance
• Change in friends
• Deterioration of hygiene
• Loss of concentration
• Lability
• Increased in secretiveness
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Screening for Opioid Problems
• Developmental Problems
• School related problems• Risky Sexual Practices
• Delinquent Behavior• Urine Drug Screens
• CAGE-AID1. Have you ever felt you ought to cut down on your drinking or drug use? 2. Have people annoyed you by criticizing your drinking or drug use? 3. Have you felt bad or guilty about your drinking or drug use? 4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to
get rid of a hangover (eye-opener)?
• CRAFFTC - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using
alcohol or drugs? R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A - Do you ever use alcohol/drugs while you are by yourself, ALONE? F - Do you ever FORGET things you did while using alcohol or drugs? F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T - Have you gotten into TROUBLE while you were using alcohol or drugs?
ASAM National Guidelines for
Treatment
The Role of The HCP
• Routine office screening must incorporate prescription drug and recreational drug use such as pharming
parties and skittling screening in all risk-taking behavior assessments.
• HCPs should be conservative and prudent when prescribing not only painkillers and controlled substances
but also all medications.
• HCPs should remain vigilant and question frequent refills or multiple prescriptions for commonly abused
medications and be cognizant of patients who “doctor shop” or “ED hop.”
• HCPs share a responsibility to support legislation that might curb access to nonregulated Internet
pharmacies and the sale of medications without prescriptions.
• Provide anticipatory guidance in emphasizing the importance of the parent-child relationship (open
communication and engagement) as a protective factor in keeping children safe.
• Educate families:1. to keep medicine cabinets locked and keep prescription drugs out of reach or out of range for both their children and friends who may
be visiting.
2. on how to prevent accidental ingestion by children, pets, or anyone else.
3. that certain expired, unwanted, or unused medicines have specific disposal instructions that indicate if they should be flushed down the sink or toilet as soon as they are no longer needed, or when they should be disposed of through a medicine take-back program.
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Interdisciplinary Case DiscussionInterdisciplinary Case Discussion
• Before John can get evaluated by mental health services for substance abuse as recommended by his PNP, he gets pulled over by the police after a “skittling party” for reckless driving on his
motorcycle. He is charged with driving under the influence and is taken to the ER for erratic behavior and evaluation of minor injuries. While in the ER, John has a respiratory arrest.
• Toxicology drug screen was positive for opioids.
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• Priority of care is acute resuscitation and stabilization
• Important to obtain as much pertinent information as possible regarding
substance(s) consumed (type, amount, timing)
• Transfer to ICU should be early on to ensure continued care of the patient
• A comprehensive history is imperative for the ICU provider assuming care
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• Challenges to the ENP role:
–Level of consciousness
–Lack of cooperation
–Denial of problem
–Embarrassment
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Patient transferred
from ED to ICU
Critical Care Challenges• Medical stabilization is always the priority
• An immediate interview with the patient may not be possible; may need to rely on family, love ones, or witnesses of the event to provide the history
• Background information would be helpful to establish treatment plan
• Monitor for potential withdrawal from substance(s)
• Developing a trusting patient relationship is important although patients may be downgraded shortly after being extubated
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Critical Care Day #2Day #2
• He is extubated, awake and alert
• Transferred out of ICU• Consult placed to inpatient psych NP for
drug evaluation
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Patient steps
down to medical floor
and a psychiatric
consultation is
ordered
The Psychiatric Mental Health Nurse The Psychiatric Mental Health Nurse
Practitioner (PMHNP) role as Practitioner (PMHNP) role as ‘‘Consultation Consultation
LiaisonLiaison’’ in General Hospital settingin General Hospital setting
• Bring specialized clinical skills with expertise in
communication, facilitation, relationahip dynamics,
and interpersonal and organizational systems
(Broom, C., Shirk, M.J., Pehrson, K.M & Peterson,
K. (2008).
• Meet with the patient and establish a therapeutic
relationship with him.
• Discuss with the patient the neurobiological chronic
disorder of addiction.
• Explain importance of screening related to his
current situation.
• Discuss with client with follow-up after discharge
for full psychiatric evaluation.
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Screening, Brief Intervention and Referral to Treatment
(SBIRT)
What is SBIRT?
SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance abuse use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.
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Screening, Brief Intervention and Referral to Treatment
(SBIRT)
• Screening is a quick, simple way to identify patients who need further assessment
• Brief intervention is a single session or multiple sessions of motivational discussion
• Brief treatment is a distinct level of care and is a communication strategic to facilitate behavior change.
• Referral to specialized treatment is provided to those identified as needing more extensive
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Screening Tools for Screening, Brief Screening Tools for Screening, Brief
Intervention, & Referral to TreatmentIntervention, & Referral to Treatment
Where can I find information on screening tools? A number of substance abuse screening tools have been developed. The use of instruments may vary based on State or local regulations, reimbursement
policies, or personal preference.
Psychiatric NP students are given both lecture and simulation experience in learning how to screen for
Substance Use Disorders (http://www.integration.samhsa.gov/clinical-practice/screening-tools)
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Screening Tools for Screening, Brief Screening Tools for Screening, Brief
Intervention, & Referral to TreatmentIntervention, & Referral to Treatment
The Alcohol Use Disorders Identification Test (AUDIT), available at: http://libdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf
The Drug Abuse Screening Test (DAST), available at: http://www.projectcork.org/clinical_tools/pdf/DAST.pdf
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), available at: http://www.who.int/substance_abuse/activities/assist_v3_english.pdf
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Rachel Humeniuk1, Robert Ali1, Thomas F. Babor2, Michael Farrell3, Maria L. Formigoni4, Jaroon Jittiwutikarn5, Roseli B. de
Lacerda6, Walter Ling7, John Marsden3, Maristela Monteiro8, Sekai Nhiwatiwa9, Hemraj Pal10, Vladimir Poznyak8 & Sara Simon7
(2009).Validation of the alcohol, smoking and substance involvement screening test (ASSIST). World Health Organization;
Addiction Report
A Screening Tool developed by the WHO
and screens for all substances; Alcohol,
Tobacco, All illicit drugs; all prescription
medications, and all OTC medication
resulting in a score.
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Alcohol, Smoking and Substance
Involvement Screening Test (ASSIST)
Psychoeducation of Opioid Health
Consequences
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Upon discharge, the patient is referred to f/u
with Primary Care.
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Primary Care PerspectivePrimary Care Perspective
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• Safe and proper use/prescribing of controlled substances
– Assessment; etiology of pain; diagnostic work-up; establish
treatment goals
– EBP recommendations
– Discuss benefits and risks (e.g. addiction, overdose) with
patient
• Clinical tools (CDC)
– How and when to taper
• Pain Management Contracts
– Organizational policy/legal considerations
• Monitoring
– Urine Drug Screen (UDS); serum (CDC, 2017 Aug.)
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Primary Care PerspectivePrimary Care Perspective
• Interprofessional collaboration with all
referring specialties
• Identifying substance use/abuse/misuse
in the primary care setting
• Collaborative endeavors
– National Alliance for Model State Drug
Laws
– DEA
(DEA, 2017; NAMSDL, 2017)
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(DEA, 2017; NAMSDL, 2017)
State Prescription Drug State Prescription Drug
Monitoring Program (PDMP)Monitoring Program (PDMP)
• Statewide electronic database; state regulated
• Collects designated data on substances
dispensed in the U.S.
• Authorized individuals under state law may
access information for purposes of their
profession
• 50 states have PDMP; 36 states mandate use of
PDMPs
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(DEA, 2017; NAMSDL, 2017)
State Prescription Drug State Prescription Drug
Monitoring Program (PDMP)Monitoring Program (PDMP)
• Benefits: PDMP is a tool used by states to address
prescription drug abuse, addiction and diversion
– Supports access to legitimate medical use of controlled
substances
– Identify & deter or prevent drug abuse/diversion
– Identify, intervene, and treatment of persons with
prescription drug addiction
– Identifying abuse trends
– Education about PDMPs use, abuse, & addiction to
prescriptions drugs
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(DEA, 2017; NAMSDL, 2017)
Ethical ConsiderationsEthical Considerations• Patient advocacy
– Protect confidentiality; legal age
– Information obtained in a PDMP – open communication
with patients
– If suspected addiction/diversion, refer for intervention
• Legal considerations
– Consult State PDMP for patients treated with controlled
substances where required by law
– PDMP record use when information is relevant
– Prescribe when appropriate
• Policy/Procedures
– Support clinical research to establish evidence relating to
best practices for opioid prescribing
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• Develop a therapeutic relationship with the patient
• Discuss the reason for referral and current concerns
• Collaboration with patient to develop a treatment plan which will foster adherence
• Treatment plan to include individual/group psychotherapy if amenable
The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting
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• Complete a psychiatric evaluation for assessment of a
co-occurring mental health and/or substance use disorder and gain a comprehensive understanding of
the identified substance use disorder
• Includes observation and interview
• Determine the appropriate level of care
• Review of medical records, diagnostic tests, and obtain history from collateral sources
The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting
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• A complete a psychiatric evaluation includes a thorough
substance use history (for each substance):
• Quantity and frequency of use
• Route of administration• Pattern of use (e.g., episodic versus continual, solitary
versus social)
• Functional, interpersonal, or legal consequences of use• Tolerance and withdrawal phenomena
• Any temporal association between substance use and
other present psychiatric illnesses
• Any self-perceived benefits of use
The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting
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• A complete a psychiatric evaluation includes a thorough
substance use history (for each substance):• Prior treatments for substance use disorders (outpatient,
IOP, residential, detoxification, h/o MAT, h/o
pharmacotherapy including Naltrexone/Vivitrol, Campral,
Antabuse)
• Periods of sustained abstinence, including their duration, recentness, and factors that aided in sobriety or contributed
to relapse
• Evaluation includes family history of both disorders of
addiction and mental health disorders
The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting
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• Urine or buccal toxicology ordered in office with script
for additional lab testing if appropriate• Basic laboratory tests
• Pregnancy test
• Thyroid function test• Lyme serology
• Syphilis serology, HIV, HCV
The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting
• Psychiatric screening tools administered to provide baseline measurement:
• Patient Health Questionnaire (PHQ-9): Depression
• Hamilton Anxiety Rating Scale (HARS): Anxiety• Opioid Risk Tool
• PDMP Report
Opioid Use
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Opioid Use
No single factor determines whether a
person will become addicted
to drugs.
Opioid Use
Disorder is a medical diagnosis
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What Can We do?What Can We do?1. SBIRT (Screening, Brief Intervention, Referral to Treatment)
2. Prescription Drug Monitoring Programs
3. Ask! “Do you have a history of addiction?”
“Does anyone in your family have a history of addiction?”
4. Use of Opioid Risk Tool
5. Toxicology Screens
6. Know the resources:
– Providers Clinical Support Systems (PCSS) http://pcss-o.org/
– International Nurses Society on Addictions www.intNSA.org
– PainEDU: www.painedu.org
– American Society of Pain Educators: http://www.paineducators.org/
52College of Nursing and Health Professions
Work TogetherWork Together
Opioid and Safe-prescribing Training
Immersion (OSTI): a multi-modal,
competency-driven and performance-based
interprofessional program –University of
Massachusetts Medical School Experience
Jill Terrien PhD, ANP-BC Presenter with acknowledgement to , Mary Zanetti, EdD
Jean Boucher PhD, ANP-BC, Melissa Fischer, MD, MEd University of Massachusetts Worcester Graduate School of Nursing
University of Massachusetts Medical School
Education meeting the needs of our
patients and the community
• How do providers: MD, NP, PA, RN, SW others gain
the education needed to assess, treat, recognize and
manage opioid use disorder across the lifespan?
• Classroom and simulation utilized within primary
education continuing education and beyond.
• Concepts in UMMS Simulation brought out in the
unfolding case of John Smith.
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• MA medical schools developed 10 competencies re:
prevention & management of prescription drug misuse
• Our goals were to:
– train graduating students in safe and effective
opioid prescribing (MD and NP students);
– prevent and minimize risks of addiction;
– identify and treat patients with substance misuse
disorders.• Antman, K. H., Berman, H. A., Flotte, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016). Developing Core Competencies for the
Prevention and Management of Prescription Drug Misuse: A Medical Education Collaboration in Massachusetts. Academic
Medicine, 91(10), 1348-1351.
The problem: a high prevalence of pain coexists with a public health crisis of opioid abuse: National and Local
GovernorGovernor’’s Working Groups Working Group
10 Competencies (Summary)
Prevent•Screen•Evaluate•Identify and Describe Options
Treat At-Risk Patients•Patient Engagement in Patient Centered Treatment Plan
Manage Substance Use Disorder•As a Chronic Disease•Eliminate Stigma
•Build Awareness of Social Determinants
Medical Education: http://www.mass.gov/eohhs/docs/dph/stop-addiction/governors-medical-
education-working-group-core-competencies.pdf
| |
Students (3rd & 4th year medical students, graduating nurse
practitioner students (FNP, AG-ACNP, AG-PCNP)) – not
graded, safe learning environment
•4-hour sessions April-June 2016 & Mar-June 2017:
– 2 hours: team of 1 faculty + 4 students participate in 4
½ hour scenarios with standardized patients (round-
robin style, each learner had a case)
– 2 hours: students attend patient panel discussion (1 hr,
facilitated by faculty) and naloxone training/case 5 (1
hr)
OSTI overview
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• Preparation:
– self-study in www.scopeofpain.com
– Faculty Development Live session (2 hours) or webinar
– not expected to be content experts; provide feedback;
emphasize key points; engage all learners; maintain safety
• Interprofessional and Interdisciplinary
- Nursing, Medicine, Pharmacy, Dentistry, Behavioral Medicine
- UMMS, VA, St Vincent’s, Cape Cod HC, Berkshire Medical Center,
Baystate Health Systems, Commonwealth Medicine, Private Community,
Fitchburg Family Health Centers
Faculty facilitators
| |
• Acute traumatic pain in a patient of color who is appropriate for treatment with opioids (orthopedic clinic)
• Chronic low back pain in a patient at high risk for opioid misuse - opioids should be discontinued (fam med clinic)
• Acute on chronic low back pain in a long-term patient on opioids; demonstrates aberrant behaviors but can continue with opioids with safeguards; nasal naloxone co-prescribed for safety (primary care clinic)
• Young woman with post-op pelvic pain and opioid misuse who requires intervention and referral to substance use treatment. (OB/GYN clinic)
• Patient s/p naloxone rescue in the field with partner in ED, rehab counseling and naloxone training
OSTI Cases
| || |
• Patients in recovery from Opioid addiction &/or their family members (2-4)—faculty facilitated
• Participants reflected on two open ended questions after the 45” encounter:
“One bias you had regarding caring for
these patients before this panel?”
“One way you think this panel will impact your care of these patients in the future?”
OSTI Panel Discussion & Self-Reflection
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• Program:
– Overall high quality experience (learners and
faculty)
– Satisfied with learning experience
• Post program:
– ‘overall, the program provided me with
knowledge that I use regularly’
Outcomes/Evaluations of OSTI
| || |
Healthcare learned bias:‘I feel like we absorb a lot of unconscious bias from our attending and those higher in the "hierarchy“’
Judging:‘I think the toughest bias to overcome is judging a patient based on his/her appearance’
General knowledge (lack of):‘I was not aware of the patients low self esteem caused by their substance abuse’
Blaming/mistrust of patients:‘Regardless of what they say or how they appear, you cannot believe them as their goal is to deceive you.’
Learners’ self-reflection: Bias
| || |
Improved medical knowledge:
‘I will always screen children for substance abuse and care about
them.’
Seeing the whole patient:
‘Understand addiction can happen to anyone’
‘Treat everyone like a human being.’
Learn about and utilize available resources:
‘I am a compassionate individual but I will do more to educate
myself of the local resources for addicts’
Advocacy: ‘The panel brings forward good points that health care
providers play a large role in changing policy’
‘Seeing the positive impact of recovery will inspire me to help
addicts get resources for recovery.’
Learners’ self-reflection: Impact
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• Curricula need to be flexible to accommodate changing needs
• Partnerships across schools and community organizations can
support that
• This is one example of simulation: there is much to be done in
the education of all healthcare providers.
• “The mentality and behavior of drug addicts and
alcoholics is wholly irrational until you understand that they are completely powerless over their addiction and unless they have structured help,
they have no hope.”• Russell Brand: Actor, Comedian, Author
In SummaryIn Summary
Thank you for your timeUMMS Opioid Conscious Curriculum Website: http://www.umassmed.edu/opioid/
65 | |
References• https://www.scopeofpain.com/ Live or online medical or cont nursing education to
manage chronic pain when appropriate with opioid analgesics safely and effectively
• http://umassmed.edu/opioid UMass Medical School website with resources and
materials
• Alford, D. P., Carney, B. L., Brett, B., Parish, S. J., & Jackson, A. H. (2016). Improving
Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical
Examination. J Grad Med Educ, 8(3), 390-397. doi:10.4300/jgme-d-15-00273.1
• Antman, K. H., Berman, H. A., Flotte, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016).
Developing core competencies for the prevention and management of prescription drug
misuse: A medical education collaboration in Massachusetts. Academic Medicine, 91(10),
1348-1351. doi:10.1097/ACM.0000000000001347
• Advanced Practice Nursing Education Core Competencies for the Prevention and
Management of Prescription Drug Misuse http://www.mass.gov/eohhs/docs/dph/stop-
addiction/governors-advance-practice-nurse-practicioner-education-working-group-
prescription-drug-misuse-core-competencies.pdf
• Governor's Opioid Working Group, T. C. o. M. (2015). Recommendations of the
Governor's Opioid Working Group. Retrieved from
http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-
governors-opioid-working-group.pdf
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ReferencesReferences
• American Psychiatric Association. (2016). Practice guidelines for the
psychiatric evaluation of adults (3rd ed.). Arlington, VA: American
Psychiatric Association.
• American Society of Addiction Medicine 2016 Facts and Figures.
Available at https://www.asam.org/docs/default-
source/advocacy/opioid-addiction-disease-facts-figures.pdf
• Broom, C., Shirk, M.J., Pehrson, K.M & Peterson, K. (2008).
Perspectives on psychiatric consultation liaison nursing. Perspectives in
Psychiatric Care, 44 (2), 131-134.
• Centers for Disease Control and Prevention (CDC), Opoid Overdose
(2017). Guidelines Resources: Clinical Tools. Retrieved from
https://www.cdc.gov/drugoverdose/prescribing/clinical-tools.html
67College of Nursing and Health Professions
ReferencesReferences
• Drug Enforcement Administration (DEA), United States Department of
Justice, Diversion Control Division (2017). State Prescription Drug
Monitoring Programs. Retrieved from
https://www.deadiversion.usdoj.gov/faq/rx_monitor.htm
• Hammond, C., Mayes, L., Potenza, M. (2014) Neurobiology of
adolescent substance use and addictive behaviors: Prevention and
treatment implications, Adolescent Med State Art Rev, 25(1):15-32.
• Jensen F., Nutt E. (2015). The Teenage Brain. Harper, New York.
• Marco, C., Venkat, A., Baker, E., Jesus, J., Geiderman, Friedman, V. et
al., (2016) Prescription drug monitoring programs: ethical issues in the
emergency department. Annuals of Emergency Medicine, 68(5): 589-
598. Doi: 10.1016/j.annemergmed.2016.04.018
68College of Nursing and Health Professions
ReferencesReferences
• National Alliance for Model State Drug Laws (NAMSDL) (2017).
Prescription Drug Monitoring Programs. Retrieved from
http://www.namsdl.org/prescription-monitoring-programs.cfm
• Simkin, D. (2016).Neurobiology of Addiction and the Adolescent Brain.
The Journal of Global Drug Policy and Practice.
• Solecki, S. & Turchi, R. (2014). Pharming: Pill parties can be deadly for
teens, Contemporary Pediatrics, 31(11), 24-27.
69College of Nursing and Health Professions