P11A.docx

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Stefanie Floyd 

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Main Question Post  Opioid abuse has been a reoccurring problem for years, however, the current epidemic came to fruition in 2013. Jones, Bruera, Abdi, & Kantarjian (2018) noted that it is the number one reason for accidental death in the United States and “Americans consume 80% of the world’s oxycodone and 90% of the world’s hydrocodone” (p. 4279). It generally starts in the hands of providers that prescribe opioids for pain and the pharmaceutical companies that supply them.  This healthcare issue definitely impacts my work setting and the future work settings for nurse practitioners. In many states, nurse practitioners have limitations on their prescriptive authorities and must be signed off by a physician. It is important that nurse practitioners are able to practice independently in order to maximize their abilities, especially to aid in combatting the opioid crisis. For example, in certain states, nurse practitioners are prohibited to prescribe buprenorphine, which is a crucial drug for treatment of opioid addiction. Poghosyan, Norful, and Laugesen (2018) researched removing restrictions through the adaptation of the Nurse Practitioners Modernization Act, where nurse practitioners with at least 3,600 hours of practice can be independent of a physician. As for my current work setting, the post anesthesia recovery unit, my main responsibility is to keep patients breathing, but also to manage their pain effectively. This can include the use of a great deal of narcotics.  My healthcare setting has responded to the opioid crisis in a more positive way than anticipated. The Emergency Room has implemented systems with the ability for providers to determine if a patient is doctor shopping for narcotics. More specifically, in the unit I work in, we have enacted the Enhanced Surgical Recovery program. This program aids in mobilizing and decreasing opioid use after surgery, while simultaneously decreasing a patient’s length of stay and producing more favorable outcomes post-operatively. Kamdar, Hoftman, Rahman, and Cannesson (2017) discuss the opportunity to change practice in the perioperative space regarding pain management. In particular, Kamdar, Hoftman, Rahman, and Cannesson (2017) discuss utilizing an opioid-free practice with appropriate patients, primarily in the Enhanced Recovery After Surgery (ERAS) setting. This is bolstered by the supposition that it could provide the best care to the patients in the short, intermediate, and long term, while also contributing to decreased length of stay and better patient satisfaction through proper education. Furthermore, it would provide anesthesiologists and nursing providers an opportunity to be on the front line in mitigating the current opioid crisis. It is also of note that much of a patient’s pain post-operatively is related to their perception pre-operatively. It is important to educate patients about the expectations they have regarding pain after surgery. If patients are informed, they tend to be more accepting of the results.  References  Jones, G. H., Bruera, E., Abdi, S., & Kantarjian, H. (2018). The opioid epidemic in the United  States- Overview, origins, and potential solutions. Cancer, 124(22). 4279-4286. Retrieved  from https://doi-org.ezp.waldenulibrary.org/10.1002/cncr.31713  Kamdar, N. V., Hoftman, N., Rahman, S., & Cannesson, M. (2017). Opioid-free analgesia in the  era of enhanced recovery after surgery and the surgical home: Implications for  postoperative outcomes and population health. Anesthesia & Analgesia, 125(4),  1089-1091. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1213/ANE. 0000000000002122  Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’  scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives.  Journal of the American Association of Nurse Practitioners, 30(6), 354-360. doi:10.1097/  JXX.0000000000000040 

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