NR 505 Week 8: Future Use of Evidence-Based Practice
NR 505 Week 8: Future Use of Evidence-Based Practice
I work in the emergency room and during my shifts I come across at least one person whose chief complain is related to chronic pain. For the most part, the primary care providers provide them with some sort of analgesic in order to manage their pain. We definitely have our regulars who come in at least once a week demanding morphine or dilaudid. PCP’s have a constant pressure to maintain high patient satisfaction scores and feel the need to negotiate the plan of care with these patients. However, many are reluctant to order or prescribe opioids or controlled substances even though because they don’t see it as appropriate to chronic pain management. Nonetheless, if these patients don’t get the drugs they seek, one knows they will be unsatisfied with their care. As mentioned by Henson and Jeffrey (2016), pilot studies can provide a better insight of the developing research, they assess sample size, data collection and clarify many questions before the implementation process. Pilot studies tend to foretell what one must expect from the actual study, therefore providing one with the opportunity to alter and adjust one’s methods. Implementing a pilot study in the ER will be challenging for me. For the most part the ER consist of pharmacological intervention and in this fast phase setting it would be difficult to implement nonpharmacological interventions. Currently, in my ER we divide our patients in two sections. One section is for our acute patients whom need to be seen by a PCP as soon as possible or whom will require numerous resources such as blood draw, xray, radiology, etc. The other section is our “fast track”, this portion of the ER sees nonemergent cases or those whom will require one to two resources such as those whom need small sutures or medication refill. Many time, some of the patients whom are complaining of chronic pain will go to the fast track section, medication will be provided, and they will be discharged. Given this setting is less acute and patients are more stable, I believe I could integrate nonpharmacological teaching and interventions. Nonetheless, in order to intergrade a pilot study, one must take many things into consideration.
Henson, A., & Jeffrey, C. (2016). Turning a clinical question into nursing research: the benefits of a pilot study. Renal Society of Australasia Journal, 12(3),99-105.
I have enjoyed reading your posts this class as you always provide great insight on the discussions. I also work in the emergency setting and see many of the same issues as you. We have a similar set up in our ER including a fast track area. It works well moving non-acute patients quickly. I like your idea regarding implementing non-pharmacological interventions for patients with chronic pain. Last week, there were discussion posts explaining the value of physical therapy for those with chronic pain. This is one of my favorite interventions to discuss with patients with chronic pain as it has the capacity to alleviate pain as well as provide overall health benefits. The pressure on providers to prescribe narcotic pain medications is a huge issue and very unfortunate. I can see why many feel pressured to give out medications for fear of being negatively criticized. We have had many discussions in our ER regarding this issue and found that through working together as a group and being consistent, our level of pain medication disbursement has gone down significantly. It began with our medical director speaking to all physicians on our new goal and continued with nursing managers and staff providing constant education to the public that things were changing and why they were changing. Overtime, we saw many patients who frequented our ER seeking pain medications for chronic issues had less visits thus lowering our overall disbursements of narcotics. Thank you again and good luck in your studies!
, I too have enjoyed reading your posts and perspective throughout our course. Your topic, like many others in our current healthcare environment, is so multifaceted and complex. Patients seeking pain management options in the ED is the result, in my opinion, of an overall fail of their health management. I continuously hear our senior leaders talk about primary care and primary prevention; as well as care across the continuum. As I read your post, I stop and think about how the many opportunities we have at every point of care a patient may receive.
There are some patients that do not have chronic health care needs, do not see a primary care provider for a health condition, and are the ones seeking medications like you described above. I agree with James’s thoughts; and your response as to how difficult a pilot would be in the ED regarding the expectations around pay for performance with this patient population. It is unrealistic to achieve high patient satisfaction scores in an ED with this population when the expectation and regulations on the clinicians and providers is to NOT prescribe narcotics. The narcotics are what the patient came to the ED for; another issue that we have all identified. I feel that until there is a true collaborative effort with all points of care patients may touch across their healthcare journey; and a solid plan to connect these patients with the additional care they may need post ED visit to address their pain, and in most cases their drug dependency, we will continue to see these opportunities and struggle to meet the goals that are set for us (pay for performance, customer satisfaction, and throughput to name a few).
Great thoughts in your post. Best of luck in future courses.
