Remembering Strategies for Safe Opioid Use

safe opioid use in the midst of the opioid crisis

Managing pain and dyspnea for people with life limiting illnesses requires safe opioid use. Dyspnea is one of the most common symptom experienced by people with COVID-19, so this is a good time to review safe strategies for using opioids.

Opioid misuse can be minimized by using risk assessment tools, contracts for opioid use, and following guidelines for safe storage and disposal. The following are examples of tools you might see or use to support safe use.

Risk Assessment Tools

When a pain or dyspnea assessment indicates the need for opioids for symptom management, a risk assessment tool can be used to help to identify those people who are more likely to struggle or be struggling with addiction issues. Identifying these people before beginning opioids can help the health care team safely manage their opioid use.

Four standardized tools are available at the website http://Opioidrisk.com. The tools vary from a 1 minute self-report to a 5 minute interview tool, offering a range of ways to assess the risk of opioid misuse.

Tell us about the tools that you use in your location. How are they different? Please post into the comments section, if possible.

Contracts and Agreements for Safe Opioid Use

Part of process for initiating opioids could include the discussion and signing of a contract, clearly outlining the person’s responsibilities for safe opioid use, including storage and disposal of medications. The contract facilitates the discussion around safe opioid use and will help establish the parameters required for safe opioid use in the home.

What types of contracts or users agreements for opioid use are you familiar with? Are they used before beginning opioids? Please add your document/contract or link it into the comments here. It would be interesting to see what is used for ensuring safe opioid use in different locations in Canada and the USA.

Tell us your thoughts on this contract linked here. Which parts are helpful and which parts don’t you like?

Sample User Agreement

Guidelines for Prescribing Opioids for Chronic Pain

2017 Canadian Guidelines for Opioid Use for Chronic Pain

Opioids -How to Use Them Safely

Guidelines for Storage and Disposal

Completing a risk assessment and contract with the person receiving the opioids can help facilitate safe opioid use. Including the following key steps (from www.healthcareprovidersolutions.com) when handling opioids will help decrease the risk of misuse and diversion:

  • Counting controlled substances at each visit for each patient, regardless of the risk of diversion in their home.  This practice is helpful for many reasons not just identification of possible diversion but may help to identify diversion early.

  • Limiting the supply of controlled substances.  In situations where diversion is known or suspected, daily deliveries of the controlled substances needed by the patient may be made or limiting the supply to just a couple of days is implemented.

  • Limiting access to the controlled substances.  This may be in the form of a lock box in the patient’s home with only certain individuals and hospice staff having access.

  • Working with the patient and family to relocate the patient to a more controlled environment such as a nursing home or hospice inpatient unit.

Health care providers need to know how to safely dispose of opioids. The following are guidelines developed for health care providers in the USA for disposing of opioids. Check for specific policies and procedures at your location.

Resources for Safe Opioid Use by Health Care Professionals and Family

Institute for Safe Medication Practices Canada – Opioid Stewardship – Brochures and downloads available

Fraser Health: Principles of Opioid Management – with specifics of safe handling and disposal of fentanyl patches

Four Strategies for Managing Opioid Side Effects

Strategies for Harm Reduction

Implementing any of these strategies for harm reduction may be helpful in reducing the current opioid crisis. Consider how to respond to people experiencing addiction with compassion and to support them in their rights to equal health care.

Canadian Nurses Association – Harm Reduction

BC Nurses Union – Position Statement on Harm Reduction

Compassionate Care for People with Addictions

Update of blog originally published in 2017

My three “must-have” professional association memberships…What are yours?

Memberships in professional associations have helped me to develop as a professional, and a hospice and palliative care provider. Through membership I have experienced opportunities for learning, providing feedback to the community and connecting with colleagues across the continent. These are my three “must-have”  memberships. I also invite you to comment here on the Blog or the Facebook page about your top three professional associations, or your thoughts on the benefits of memberships in professional associations.

Canadian Hospice Palliative Care Nurses Group (CHPC NG)

CHPCA

The Nurses Group (a subgroup of the Canadian Hospice Palliative Care Association) is a MUST for all nurses interested in hospice and palliative care in Canada. YOU DO NOT NEED TO work in specialty hospice or palliative care units to benefit from this group! As health care integrates a palliative approach into care, all nurses will need knowledge and skills in hospice and palliative care. In this group you can access a “members only community of practice” site and accrue HPC certification hours. All members can participate in and enhance the collective national voice of HPC nursing, influence policy development, legislation and practice. You can be elected to the CHPCNG board of directors, serve on committees, be nominated for one of two awards that recognize HPC nurse leaders in Canada. I am delighted to serve on this board, and honoured to rub shoulders with great nurses from across Canada.
You can join this group if you are an RN, NP, LPN/RPN, RPN or nursing student in Canada. Membership is April 1st to March 31st.
To join the CHPCA, go to http://membership.chpca.net/. To join the CHPC NG, use this link

Nurse Educators Interest Group – Palliative and End of Life Care (Canadian Association of Schools of Nursing (CASN))

 

 

CASN interest groups provide nurse educators an opportunity to discuss ideas, exchange information, build research and scholarship capacity, as well as promote quality of a specific area of nursing education, at a national level.

This is an excellent group for educators who have a particular desire to strengthen palliative care education in core curriculum, continuing education, and workplace education.  As with the CHPC NG, this group provides members with the opportunity to connect, dialogue, share resources, build capacity, exchange ideas to strengthen palliative care in Canada, and to contribute to national dialogue. This group meets four times a year via teleconference. For more information and to join this group, https://www.casn.ca/about-casn/nurse-educator-interest-groups/

Hospice and Palliative Nurses Association

In the United States, this is a strong group, and like the Canadian group, provides members with the opportunities to network, contribute to national discussion, participate in annual conferences, build community of practice, and grow in the profession. There are a variety of special interest groups, and opportunity for certification, fellowships, scholarships… and more! An interesting sidenote: the CEO of HPNA is Sally Welsh, who is very active on Twitter. She can  link you with discussion on many current issues. For more information on this group, use this link

 

I invite you to consider membership in these organizations! Are there organizations that are your “must have” memberships? Let us know in a comment.