Date of Award

10-2018

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Amy Manderscheid DNP, RN, CMSRN

Second Advisor

Rebecca Davis PhD, RN

Third Advisor

Kimberly Lanning, DNP, MSN, FNP-BC, APRN

Abstract

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et al., 2016). The use of opioid pain medication presents serious risks for patients receiving them, including overdose and opioid use disorder (Dowell et al., 2016). Long-term use of opioids for chronic pain is controversial and has been linked to dose-dependent harm, addiction, overdose, and death (Zgierska et al., 2018). Approximately 85% of those who misuse opioids obtain their main drug supply from opioid prescriptions (Zgierska et al., 2018). On the basis of Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria, it is estimated that 1.9 million Americans abuse or are dependent on prescription opioids (Dowell et al., 2016). Opioid-related deaths in the United States have increased dramatically, making this a national public health crisis (Zgierska et al., 2018).

Objectives: The primary study objective is to assess whether evidence-based practice guidelines are being followed regarding the care being delivered to opioid recipient patients.

Methods: This is a quality improvement project that will include a retrospective evaluation of quality measures for evidence-based care being delivered to opioid recipients. This project will occur at a primary care office that is part of a large mid-western healthcare system. Resources needed for this project include access to patient charts located at the primary care clinic, use of a laptop, space within the primary care clinic in which to work, and materials needed to produce a toolkit. Additional resources include collaboration with the site mentor and office manager, utilization of information technology (IT) personnel, and consultations with a statistician. To be included in the analysis, patients must meet the following inclusive criteria: age greater than or equal to 18 years old; active patient status (seen in the past three years); have a primary care provider within this office; do not have a diagnosis of malignant neoplasm or hospice status; and have at least one opioid prescription in the past 45 days that was not prescribed for acute pain. Medical records will be reviewed for adult patients at the primary care clinic who are currently prescribed opioids. Furthermore, medical records will be assessed for quality measures of evidence-based care. Evidence-based action plans and a toolkit will be presented and provided to the primary care office’s leaders, providers, and staff to continue to improve measures reflecting organizational goals and measurement targets.

Results: Expected results include potential gaps of continual improvement in evidence-based care that is being provided to patients in the primary care setting.

Conclusions: Expected conclusions include identified areas of quality measures for evidence-based care.

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