Decreasing Opioid Utilization in Rehabilitation Patients Using a Clinical Nurse Specialist Pain Consultant Program.

Authors: Urton MS, Rohlik E, Farrell M, Ng W, Woodard EK


Arch Phys Med Rehabil. 2017 Jun 28;:

OBJECTIVE: To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization.
DESIGN: Retrospective chart review of patients discharged during six months prior to and six months following introduction of the CNS role.
SETTING: Not-for-profit 98-bed community inpatient rehabilitation hospital.
PARTICIPANTS: Two population-based samples of adult, inpatient rehabilitation patients with daily opioid use ≥ 30 mg morphine equivalent dose (MED)/day on admission and length of stay ≥ 24 days.
INTERVENTIONS: Implementation of a CNS pain consult program.
MAIN OUTCOME MEASURES: Change in average daily opioid use (mg MED/day), measured at admission, Week 1, Week 2, and Week 3.
RESULTS: Linear Mixed Modeling was used to estimate individual and group-average opioid trajectories, including individual patient intercepts (opioid use at admission) and slopes (change in opioid use over time). There was a significant interaction between group and time, b= 5.75, t = 2.52, p < 0.01, indicating faster change in opioid use for the CNS group (quadratic slope= -5.91) compared to the No CNS group (quadratic slope=-0.16). Quadratic change in the CNS group reflected an initial increase in opioid use from Admission to Week 1, followed by a steady decline. Conversely, there was virtually no change in the No CNS group. Random effects revealed considerable variability in opioid trajectories across patients.
CONCLUSIONS: Addition of a clinical nurse specialist pain consultant program to an inpatient rehabilitation hospital supported a distinct pattern of opioid tapering that promoted more rapid titration of daily opioid use across the rehabilitation hospitalization. Key Words: Pain, Clinical Nurse Specialist, Rehabilitation, Consultation.



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