National Practice Problem Exploration

Addressing healthcare problems that have a large impact on individuals in our society, have been at the forefront of quality improvement initiatives. Identifying these areas of concern can be helpful for DNP prepared nurses to stimulate and create effective change that may be needed. One of the areas of concern identified is Opioid. Opioid use disorder is a national problem in the United States of America.  According to the US Burden of Disease Collaborators (2018), opioid use disorder (OUD) is the number 7 leading cause of morbidity and mortality in the US. As a mental health practitioner, OUD and other substance abuse are common problems I see in my patient population. This national burden is directly related to my daily practice because most of the patient population seen in the clinic are also being prescribed opioids for chronic pain for various reason from other providers.  In rural Tennessee where I practice, the small town is well known for drug abuse and drug overdose.  I have learned from my previous collaborator, to be very careful when prescribing antianxiety medications or any type of control substance, since at the time I was the new provider in the area.

OUD impacts nurses as it requires a multifaceted approach involving various interdisciplinary members where a nurse may take a leadership position in the patient’s care (Eckart et al., 2020). As a profession, nursing science advances knowledge to recognize, prevent, and treat OUD (Eckart et al., 2020). Health care organizations serve as the umbrella to support multidisciplinary teams in treating OUD. Last but not least, quality of care could be affected by prescriber practices, social stigma, and lack of resources that correlate to OUD (Eckart et al., 2020).

A couple of crucial national stakeholders come to mind with OUD: the Centers for Disease Control and Prevention (CDC) and Drug Enforcement Agency (DEA). The CDC plays a significant role in providing OUD guidance for the public, including clinicians and patients. The DEA plays another vital role in monitoring and regulating prescribers plus controlled substance prescriptions. Micro level stakeholders impacted by the resolution of this issue include patients, as well as community members who have day to day interactions with the patients.

At this time, there is a clinical practice guideline (CPG) issued by the CDC.  Clinicians in primary care have found that managing chronic pain can be a daunting task; therefore, the CDC has issued a CPG on prescribing treatment for chronic pain (Dowell, Haegerich, & Chou, 2016). Using a systematic review to assess benefits, risks, values, preferences, and costs, the CDC has issued 12 recommendations to clinicians when prescribing opioids (Dowell et al., 2016). The recommendations advise that clinicians avoid prescribing opioids if possible, take a stepwise dose approach if prescribing opioids is unavoidable, establish goals of treatment with patients before prescribing, and closely monitor patients for response to treatment; the recommendations also include avoiding concurrent use of other opioids or benzodiazepines, in addition to providing medication assisted treatment for OUD (Dowell et a., 2016).

The CPG provided the CDC has been a mainstay to patient education in my practice. My collaborating physician and I rarely issue opioid prescriptions. We often encounter frustrated patients when they are refused opioid prescriptions after having been given opioids from the emergent care setting; this is a time-consuming issue faced frequently in may primary care clinics (Tong et al., 2019). To improve patient safety and satisfaction, counseling is important to de-escalate patient frustrations and help them perceive the potential harms to opioid use.

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