- Throughout the nation, healthcare professionals are working to tackle the opioid crisis. On the one hand, clinicians understand that prescribing these pills can contribute to addiction. On the other, clinicians want patients to be able to access the pain management drugs they need.
Healthcare professionals are cognizant of the fact that opioid prescribing could lead down a dangerous path toward addiction. Eighty percent of heroin users began this drug misuse with a prescribed opioid, according to research from SAMHSA. And yet clinicians have an obligation to deliver quality care to patients, ensuring they do not feel unnecessary pain.
Opioids can do a lot of good and should not be wiped from pharmacists’ shelves, most experts agree, so long as they are being prescribed and taken judiciously. But how do providers make sure that happens?
At the heart of this is prescribing opioids alongside strong patient education. While providers must enable patients in need with the medications that will help them, they must also ensure patients understand the risks associated with these drugs.
At Cox Health, providers lean on patient engagement technology to do the job. According to the organization’s patient engagement coordinator Tina Tarter Hamlet, these tools offer comprehensive patient education and arm patients with the tools needed to spark meaningful conversations about pain management and patient safety.
Tarter Hamlet and her team employed tools from TeleHealth Services, a company that specializes in video- and technology-based patient education. These videos help patients understand the risks involved with taking an opioid, what it looks like when they are misusing that opioid, and how to dispose of drugs they no longer need.
These education tools have been especially useful in the surgical department, where many patients are eventually prescribed some sort of opioid painkiller.
“The biggest utilizers of our opioids in our health system are surgical patients, so that is the population that we targeted,” Tarter Hamlet said in an interview with PatientEngagementHIT.com.
“Our education starts in the surgeon's office when patients find out they have to have surgery,” she continued. “When they're in the doctor's office, they have a conversation with their surgeon about pain management, and the surgeon gets them a pamphlet that talks about how we measure pain. The pamphlet also talks about benefits and adverse effects of opioids, as well as other methods to control pain other than opioid medication.”
Alternatives can include repositioning the patient, heat or ice packs, relaxation, or meditation, Tarter Hamlet explained.
Patient education continues when patients return for surgery, Tarter Hamlet explained. During the pre-admission process, patients view a video about pain management. Although the video reiterates much of the same information as the pamphlet, it is important to underscore pain management prior to surgery.
Following surgery, patients view another video about how doctors and nurses will control pain while in the hospital. Closer to discharge, patients watch a CDC video about opioid medications, what patients should expect, and questions they may wish to ask their doctors.
“This would be information about how to transition from opioid pain medicine to over-the-counter pain medicine,” Tarter Hamlet said. “It also talks about how to dispose of opioids safely when they are no longer needed to prevent diversion. It also talks about signs and symptoms of opioid overdose and what to do if you think you've taken too many opioids or if you're with someone or know somebody who's taken too many opioids.”
This may seem like information overload, but Tarter Hamlet said this high level of patient education is not only essential, but something patients want.
With mainstream media coverage of the opioid crisis at an all-time high, Tarter Hamlet has found more engaged patients who are concerned about their own opioid use following surgery.
“A lot of our patients are asking questions because they hear about the opioid crisis on the media. They've read about it in newspapers and they've heard about it on their local as well as their national news,” she explained. “Some people are worried that if they take opioids they might become addicted to them, and so we have to talk to the patients about ways that they can take the opioids safely.”
In short, better patient education is not a burden, but a comfort, for these patients.
Essential to these conversations is confronting the fact that the patient will experience some level of pain following surgery. While clinicians want to control that pain enough to allow the patient to ambulate post-surgery and begin any physical or occupational therapy they may need, a tolerable and realistic pain level is to be expected.
“If a patient is going to come in and have surgery, it's not realistic to think that they’re not going to have any pain,” Tarter Hamlet asserted, noting that prescribing enough opioids to get rid of all pain is dangerous.
“We talk to patients a lot about pain goals and what is a realistic pain goal because we want them to be able to eat and to sleep and get up and ambulate and recover safely without taking too much pain medicine,” she added. “We want them to be comfortable enough to do the things that they need to do to recover from their surgery and stay healthy.”
They key to ensuring that discussions of opioid use and pain management is having conversations prior to surgery. It is at this point, before the patient has faced any significant pain, that they are most prepared to discuss realistic pain and the use of non-opioid alternatives.
The fact is, opioid pain management and satisfaction are linked, data shows. When patients are prescribed an opioid following their surgery, they are more likely to give top-box patient satisfaction scores. This is not necessarily because patients need an opioid to manage pain, but because they expect it.
But when providers discuss the use of non-opioid alternatives and even the baseline pain patients will inevitably feel before surgery, patients may be more likely to be accepting.
“You really need to have the conversations before the surgery, because once the patient is in excruciating pain, it is not the time to suggest an ice pack or repositioning,” Tarter Hamlet cautioned. “Talk to them before their surgery, before they even have the pain and discuss the things they can do in conjunction with the opioids so that the opioids aren't the only thing that they're expecting us to do for them.”
It is also essential for patients to understand the pain scale providers use to assess their pain. Because a provider can never truly feel a patient’s pain, making clear expectations and creating an understanding between patient and provider will be key.
Most organizations across the country use the same pain scale, Tarter Hamlet said. The scale ranges between one and 10 and allows providers to account for comorbidities and other special patient circumstances. There is also a pain scale for pediatrics, she said.
“For a lot of people, a pain goal of three would be tolerable pain,” Tarter Hamlet advised. “A pain level of 10 would be the worst pain you've ever had in your life. Most people after surgery are going to have excruciating pain. We want to control their pain, but we also want them to be able to eat, to drink, to ambulate, and to do those things they need to do to recover and not develop complications.”
Cox Health uses a comprehensive nurse rounding and communication strategy to make sure they maintain that target pain level.
“That helps the nurse to know if they should get some pain medication or maybe just reposition the patient or use another meditative strategy to help the patient feel better,” Tarter Hamlet explained.
For example, if a patient’s pain goal is a three and they are reporting a five, it probably isn’t time for another dose of opioids. It is a better strategy to reposition or use another non-opioid pain management solution.
Of course, a patient may not always be welcoming of a non-opioid approach, even after they have discussed it with their provider pre-surgery. Approaching these rifts with patients in a compassionate manner and with solutions to make things better will help providers create a more satisfactory experience. Additionally, providers can remind patients of their wishes pre-surgery when they were free of pain.
In this way, providers need to lean on patients as a part of the care team.
“It's really a team approach and the patient is a big part of that, because they know what pain they're experiencing and we just have to have a way to measure that with the patient's help,” Tarter Hamlet concluded.