ripples from the opioid epidemic in ways that are not related
to misuse or addiction. The crisis has created challenges with
pain management that affect a resident’s quality of life”
(Fagan, 2018). Senior care residents often need serious pain
management, and the epidemic creates a situation where
clinicians may be more reluctant to prescribe as readily as
they once did. Diversion can be a large risk in this care sector
as well. The solution to avoiding problems is a combination of
effective medication management, appropriate policies and
procedures, staff education, and strong narcotic reconciliation
and disposal measures (Fagan, 2018).
Ambulatory Surgery Centers (ASCs)
The Ambulatory Surgery Center Association (ASCA)
“supports a comprehensive solution to address the abuse
and misuse of opioids that is fueling a tragic epidemic.” One
part of this is focused on pain management and using
non-opioid pain management techniques whenever
appropriate. ASCA also encourages all clinicians working
in ASCs to receive ongoing training about best practices in
pain management as well as effective education of patients
and caregivers (ASCA, n.d.). 53 million surgical procedures
are performed annually in an outpatient setting, most of
them involving a postoperative opioid prescription. Clinical
Pain Advisor cites a Current Pain and Headache Reports
study linking “the prescription of opioids after short-stay
surgery to a 44% greater risk for prolonged opioid use”
and advises “meticulous weaning of pain medications
post-operatively” in patients (Rodriguez, 2018).
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The hospital is not the only care
environment with responsibility when
it comes to dealing with the opioid
abuse epidemic.
misunderstandings of policies combine to make it harder
for hospice doctors to get their patients drugs like morphine”
(Karlin-Smith and Ehley, 2018). At the same time, hospices
are often on the front lines of the opioid epidemic, providing
bereavement care to grieving loved ones, and destroying
powerful narcotics after a patient’s death to prevent any
unlawful medication diversion (Baxter, 2018).
Home Health
Professional providers of home healthcare are well-placed
to have an impact on the opioid abuse epidemic. The
mental health team at Visiting Nurse Association of Ohio
suggests there are four ways homecare professionals can
help combat the opioid crisis:
• Monitor patients and the home environment for signs
of substance abuse
• Educate patients about preventing opioid dependence
• Safely dispose of expired or unneeded medication
• Refer patients to other healthcare professionals if
addiction issues are identified or appear likely (Visiting
Nurse Association of Ohio, 2017)
Hospice/Palliative Care Urgent Care
Patients receiving treatment in a hospice environment are
paying a price for the more restricted approach to opioid
prescription. Even though “CDC prescribing guidelines and
state laws limiting prescriptions generally don’t restrict opioids
for these patients… hospice and palliative care physicians
report that their patients are having a very difficult time
getting the pain control they need” (Karlin-Smith and
Ehley, 2018). The same article continues by sharing how “A
combination of opioid shortages, prescribing limits, and Urgent care providers can play an important role for those
struggling with opioid abuse. The 9,000 urgent care centers
across the U.S. are vital connections to the healthcare system.
They should practice safe levels of prescribing, act as a referral
source for further treatment, and importantly serve as a
location for the initiation of medication-assisted treatment
(MAT) with buprenorphine or naltrexone, which can help
save lives that can then be treated elsewhere (Ramos and
Crausman, 2017).