Margaret Costello, PhD, RN, clinical nurse, formerly of Tower 15CD,
and Sarah Thompson, MSN, RN, CCNS, CWON, clinical nurse educator, Tower 15CD

Sarah Thompson, MSN, RN, CCNS, CWON, (left) and Margaret Costello, PhD, RN, at the Sigma Theta Tau National Nursing Research Conference in Puerto Rico, where they gave both an oral and  a poster presentation.

Sarah Thompson, MSN, RN, CCNS, CWON, (left) and Margaret Costello, PhD, RN, at the Sigma Theta Tau National Nursing Research Conference in Puerto Rico, where they gave both an oral and a poster presentation.

Approximately 51.4 million inpatient surgical procedures were performed in the U.S. in 2010, the last year for which data are available. Many postsurgical patients are discharged with prescriptions for opioid analgesics, and there’s evidence that they often don’t know how to manage their prescription medications safely.

This lack of knowledge undoubtedly contributes to nonmedical use of prescription drugs, which is defined by the United Nations Office on Drugs and Crime as “taking prescription drug, whether obtained by prescription or otherwise, other than in the manner or for the reasons or time period prescribed, or by a person for whom the drug was not prescribed.”

Though most people are aware of the seriousness of opioid addiction, they tend to associate it with the use of illegal narcotics, such as heroin, rather than the nonmedical use of prescription opioid analgesics. However, the latter can also have serious consequences. According to the Centers for Disease Control and Prevention (CDC), there were over 18,000 deaths in the U.S. related to prescription opioid pain relievers in 2014.

Given the alarming rates of opioid abuse and overdose deaths, it is imperative that patients be well-informed about this class of medications before they leave the hospital. Unfortunately, in the busy inpatient environment, opioid education is too often put off until the last day of hospitalization, as the patient is being discharged. Patient education can be optimized by initiating it early in the patient’s hospital stay, bearing in mind that starting as early as admission may be inefficient because anxiety before surgery may interfere with learning. To ensure that patients with opioid prescriptions are discharged safely, they must be taught:

  • the proper use, weaning off and storage of opioids
  • the benefits, adverse effects and risks associated with opioids, including the possibility of tolerance, dependence and addiction
  • how to dispose of unused opioids
  • when and how to contact the prescriber

Research indicates that many health professionals, including nurses, lack the knowledge necessary to provide patients with information on the safe use of opioids. In 2012, The Joint Commission called for greater hospital staff education on the safe use of opioid analgesics.

We have been conducting research designed to improve nurses’ and patients’ understanding of safe opioid use. Our article entitled, “Preventing Opioid Misuse and Potential Abuse: The Nurse’s Role in Patient Education,” was published in Pain Management Nursing in 2014 and Costello’s article entitled, “Prescription Opioid Analgesics: Promoting Patient Safety with Better Patient Education,” was published in the American Journal of Nursing (AJN) in 2015. We presented our research findings in July 2015 at the 26th annual Sigma Theta Tau International Nursing Research Congress in San Juan, Puerto Rico. Our second study found that nurses were influential in increasing patients understanding of safe use of opioids; that article is scheduled for publication in MEDSURG Nursing later this year.

Opioids are a necessary and effective class of medications and are safe when prescribed, used, stored and disposed of appropriately. Without the pain relief these medications provide, many patients would be unable to engage in postoperative activities that are essential to their recovery, such as ambulation. However, it is imperative that patients fully understand the risks involved with these medications. The nurse’s role in patient education is invaluable to patients’ understanding of the safe management of opioids.

We have created a patient education information sheet, called “Opioid Medicine Information,” which can be found at Pike Notes/Patient Care/Patient Education/BWH Brochures and Booklets A-Z, under O.  Please email questions to Sarah Thompson at sthompson1@partners.org.