OPIOID CRISIS

Lab Group D
Rachel Danner, Caroline Denker, David Ellis, Chelsea Lovitt, Ashley Nickell,
Kiersten Patterson, Zoe Rosin, Bailee Thompson & Christine Walsh
PICOT QUESTION
Among patients in the high acuity
setting, does education prior to
discharge vs. no education decrease
opioid misuse over one year?
 An estimated 130 people die
every day from opioid related
drug overdose (HHS, 2020).

Introduction: 10.3 million people misused

The Opioid prescription opioids in 2018
Crisis (HHS, 2020).

The top cause of injury death in

the US is a result of opioid misuse
(Waszak et. al., 2017)
Introduction: The Nurse’s
Role
■ While nurses are not the ones to prescribe
medications, they play a vital role in patient education
for proper use of opioids upon discharge.
■ The ANA states that nurses are the front line of the
opioid epidemic because they are the ones to assess
pain, provide medication education and manage the
patient’s problems (2018).
 Banner follows the 2018 Arizona Opioid
Prescribing Guidelines (Banner UHP, 2020).

Banner provides a 24/7 Opioid Assistance &

Synopsis of Referral Line (Banner Health, 2020).

Current
Practice There are currently no guidelines in place for
patient discharge teaching with opioids
(Banner Health, 2020).

There are currently no guidelines in place for

education to be completed by nurses on
opioids (Banner Health, 2020).
Patient mediation Overall, nurses’ current
education is not knowledge and
happening consistently understanding of opioids
(Waszak et al., 2018). is not adequate.

Synopsis of Current Literature

Synopsis of Current Literature
Nurse education: Patient education:
■ Lacking:
 Lack teaching on opioid overdose risk
– Pain management  (Costello et al.,
(Reichheld et al., 2019).
2016)
– Signs of overdose & naloxone  Effective measures:
treatment (Kaiser, 2020) -- Pamphlet or computer  (Dunn et
■ Nursing knowledge tied to patient al., 2017)
understanding (Costello & Thompson, -- Animation-style media
2015) (Chakravarthy et al., 2018)
Synopsis of Current Literature: Patient
Education

Animation-style media
Opioid overdose risk Pamphlets shown to
enhances knowledge
is lacking (Reichheld increase retention
(Chakravarthy et al.,
et al., 2019) (Dunn et al., 2017)
2018)
Synopsis of Current Literature: Nurse
Education

Few recognize signs & Pain management

Nurse knowledge tied to patient
symptoms of overdose knowledge is lacking
understanding (Castello &
(Kaiser, 2020) (Castello et al., 2016)
Thompson, 2015)
Summary of Strengths and Limitations

• Randomization was used in every study

Strengths: • High level of participation (Reichheld et al., 2019)
• Representative samples (Kaiser, 2020)

• Not much research about baseline knowledge of patients

regarding opioids (Chakravarthy et al., 2020)
Limitations: • Patients needed to be consented after randomization which
led to selection bias (McCarthy et al., 2019)
• Surveys were brief (Reichheld et al., 2019)
Nursing Recommendations for Best
Practice
Recommendation:
■ It is recommended that nurses gain more knowledge on safe opioid use in order to provide
effective nurse-led patient education upon discharge.

Application:
■ High-acuity nurses should biannually attend an hour-long seminar that will educate and test
them on their knowledge of opioid use. Their level of knowledge regarding how to provide
proper discharge teaching about opioids will increase.
Implementation into Nursing Process
■ Nurses in the high acuity setting would be required to attend a
1 hour training twice a year that focuses on improving nurse
knowledge and teaching skills about:
– Symptoms of opioid overdose
– Risks of addiction and misuse
– Disposal and storage of opioids in patients’ homes
– Schedule adherence
– The benefits of using opioids in the intended way for the
intended purpose. 
■ These trainings would be led by the nurse educator for the
high acuity floor.
Cost Analysis
Study examined the relationship between opioid abuse/dependence (A/D) and the amount of
healthcare resources needed and cost for those resources after major OR procedures. The study
found:
– Of over 16 million participants 0.6% had opioid A/D
– Opioid A/D patients were at higher risk of 30-day readmission
– Required on average 2 more days of initial inpatient treatment (4v6 days)
– 1 more day of treatment on readmission (5v6 days).
– Initial visits cost $2,000 more for opioid A/D patients

Patients with Opioid abuse and dependence are correlated with higher rates of readmission to the
hospital and utilization of healthcare resources after surgery
(Atul, et. al, 2018)
 Cost Analysis: Opioid Addiction Treatment
Banner University Medical Center Opioid Overdose Median Cost Per Hospital Stay:

With Major Complications: Without Major Complications:

$35,645 $20,533 
 Cost Analysis: Implementing the EBP

Average Banner ICU Nursing Salary

– Range is $30 - $40 per hour based on time and experience 
– Average is $32.50 

Each acute care nurse will be paid for an hour of training twice a year: Approximately $64 per year per nurse 

In the first year, approximately 500 nurses will complete the training which will cost $32,000 

(Demase, Personal Communication, April 1, 2020) 

 Cost Analysis: Implementing the EBP
This teaching will be an additional responsibility of the existing nurse educator, meaning that
there will not be an additional salary to implement this program. 
Clinical nurse educators at Banner make approximately $40 per hour  (Demase, Personal
Communication, April 1, 2020)
The nurse educator will be paid $2,000 to lead 50 course sessions
The nurse educator will have a budget of $5,000 to develop the course
All course materials will be digital, resulting in no additional cost

TOTAL COST TO IMPLEMENT IN FIRST YEAR: APPROXIMATELY $39,000

 Risk vs. Benefit
Risk
– Nurses
■ Nurses would be off the unit for an hour, handing their patients off to another
nurse
■ High acuity patients are unstable and have an increased risk of abrupt status
changes
–  Patient
■ Understaffing during the 1-hour time frame of the seminar puts the patient at risk
for inadequate care and monitoring
■ Patient dissatisfaction
– Institution:
■ Inadequate staffing increases risk for an adverse events
Risk vs. Benefit
Benefit
– Nurses:
■ Education on safe opioid use provides nurses with the knowledge to care for patient
receiving opioids
■ This knowledge would maximize discharge teaching by informing the patient on opioid use,
misuse, benefits and risks, side effects, and signs of addiction associated with opioids
■ Gives the nurses the confidence to answer any questions concerning opioids
– Patient
■ With adequate discharge education associated with opioid use, the patient will have a more
informed understanding of how to take opioids as prescribed 
– Reducing opioid misuse, addiction, and readmission to hospitals
– Institution:
■ Adequate opioid education on discharge reduces the patient’s risk of readmission 
– Conserving valuable resources and ultimately reducing overall costs for the institution 
 Evaluation: Timeline
Plan for implementation: April 3, 2020- May 1, 2021
■ Existing nurse educator will complete the development of opioid training curriculum with a
tentative schedule of 30 sessions a year. Submit plan to Banners policy review board by April 17,
2020. 
■ Banner Health will review proposed opioid training curriculum by April 30, 2020 and make
necessary changes. The new mandatory biannual opioid compliance training will be effective May
1, 2020 . Nurses will use signup sheets now located in all ICU units at their main information desk.
■ All high acuity nurses will ensure self compliance of at least one training session completed by
October 1, 2020 and completion of two training sessions prior to May, 1 2021. 
■ Renewal date for compliance will be set at May 1, 2021. Annual audits will continue as normal and
be completed by May 1, 2021.  
Evaluation
■ Our intervention will be successfully implemented by May 1, 2021 when the existing
nurse educator developed an hour long training session on opioid knowledge and
effective discharge teaching skills as well as the completion of biannual training  for
500 high acuity nurses at Banner University Medical Center-Tucson. 
– Nurse signup sheets posted at the main information desk by May 1, 2020,
electronic sign-in sheet for training completion (dependent on training session) 
■ We expect a decrease of 20% or more in the number of opioid misuse related admission
to the ICU units at Banner University Medical Center-Tucson within the first year of
biannual opioid education training for high acuity nurses from May 1, 2020-May 1,
2021. 
– Data will be analyzed through internal database and ICD-10-CM 
– At least 5% to be related to gained knowledge on the benefits of proper use of
opioids 
– At least 5% to be related to opioid schedule adherence 
Project Overview
■ Introduction
– Within the US, opioid misuse is the top cause of injury related death (Waszak et. al., 2018)
■ Current Issue
– There is a lack of effective patient education upon discharge with an opioid prescription.
■ Current Practice
– Nurses provide medication education to patients with an opioid prescription as they would
with any prescription with discharge. However, it is possible this does not always occur.
■ Application to Facility
– It is recommended facilities implement and enforce a nurse-led biannual opioid education
training.
■ Cost Analysis
– This will cost approximately $39,000 to implement within the first year.
■ Risk vs. Benefit
– Discharge teaching on safe opioid education will be maximized, reducing the risk of hospital
readmission and treatment/cost of patients admitted with opioid overdose.
Conclusion
■ Drug overdose has surpassed motor vehicle
accidents as the leading cause of injury death in
the US (Waszak, et al. 2018).
■ Nurses are at the front lines of the opioid
epidemic (ANA, 2018).
■ In your own future practice, we challenge you
to become knowledgeable on opioid
prescription safety.

Action is needed now.

 References
American Nurses Association. (2018). The opioid epidemic: The evolving role of nursing. Retrieved from https://www.nursingworld.org/practice-policy/work-

environment/health-safety/opioid- epidemic/

Atul G., Nizadmuddin, J, Elmofty, D., Nizamuddin, S. L., Tung, A., Minhaj, M., Mueller, A., Apfelbaum, J., and Shahul, S. (2018). Opioid abuse or dependence increases

30-day readmission rates after major operating room procedures. Perioperative Medicine. 128: 880-890. Doi: 10.1097/ALN.000000000000002136

Banner Health. (2020). Opioid Assisstance and Refferal Line. Retrieved from https://www.bannerhealth.com/services/poison-drug-information/opioid-assistance

Banner University Health Plans. (2020). Opioid Management. Retrieved from https://www.banneruhp.com/resources/opioid-management

Banner Health Inpatient Services. (2019). Hospital- Inpatient and Outpatient Direct Pay Prices 2019. Retrieved

from https://www.bannerhealth.com/patients/billing/pricing-resources/arizona- common-prices/arizona-hospital-inpatient-and-outpatient

Costello, M., & Thompson, S. (2015). Preventing Opioid Misuse and Potential Abuse: The Nurse's Role in Patient Education. Pain Management Nursing, 16(4), 515-519.

Costello, M., Thompson, S., Aurelien, J., & Luc, T. (2016). Patient opioid education: Research shows nurses' knowledge of opioids makes a difference. MedSurg Nursing,

25(5), 307-311,333.
References Continued
Chakravarthy, B., Somasundaram, S., Mogi, J., Burns, R., Hoonpongsimanont, W., Wiechmann, W., & Lotfipour, S. (2018). Randomized pilot trial measuring

knowledge acquisition of opioid education in emergency department patients using a novel media platform. Substance Abuse, 39(1), 27-31.

Dunn, K. E., Yepez-Laubach, C., Nuzzo, P. A., Fingerhood, M., Kelly, A., Berman, S., & Bigelow, G. E. (2017). Randomized  controlled trial of a computerized

opioid overdose education intervention. Drug and Alcohol Dependence, 173, 39–47. doi:10.1016/j.drugalcdep.2016.12.003

Kaiser, J. (2020). Nurse’s knowledge of opioids. Journal of Nursing Care Quality, 00(00), 1-5, DOI: 10.1097/NCQ.0000000000000470

McCarthy, D., Curtis, L., Courtney, D., Cameron, K., Lank, P., Kim, H., . . . Wolf, K. (2019). A Multifaceted Intervention to Improve  Patient Knowledge and Safe

Use of Opioids: Results of the ED EMC2 Randomized Controlled Trial. Academic Emergency Medicine, 26(12), 1311-1325.

Reichheld, A., Hills-Evans, K., Sheehan, J., Tocci, N., Tandon, M., Hsu, D., Stevens, J. (2019). A national survey of approaches to  manage the ICU patient with

opioid use disorder. Journal of Critical Care, 54, 42-47.

References Continued

US Department of Health and Human Services. (2020). What is the US Opioid Epidemic?. Retrieved

from https://www.hhs.gov/opioids/about-the-epidemic/index.html

Waszak, D. L., Mithchell, A. M., Ren, D., & Fennimore, L. A. (2018). A quality improvement project

to improve education provided by nurses to ED patients prescribed opioid analgesics at discharge.

Journal of Emergency Nursing. 44(4). 336-344.’