Opioid Management in the ICU: A Balancing Act

Although the rate of prescribing opioids has begun to fall in the U.S., the misuse and abuse of opioids prescribed to patients with acute and chronic pain occurs at unprecedented levels.

Join speaker Catherine M. Ewing on Monday, May 21, from 4:45-5:45 p.m., in room 258A, to learn about the challenges facing nurses when balancing proper opioid management for postsurgical and post-trauma patients in the ICU.

During the session “Nurse’s Role in the Opioid Epidemic,” Ewing will define acute versus chronic pain and discuss recent changes to the Centers for Disease Control and Prevention’s recommendations.

“The purpose of these guidelines is not to deny people pain medications but to prescribe safely and have prescribers practice follow-up,” says Ewing, a registered nurse from the Department of Anesthesia Inpatient Pain Service at the Mayo Clinic, Rochester, Minnesota.

Ewing will discuss how patients are not all the same and how guidelines should be used as a starting point for treatment. In her institution, the surgical and trauma departments created a tiered system for pain levels that patients may experience from various procedures and injuries. These levels then help departments prepare appropriate guidelines for treatment recommendations.

“There is a short window for patients — usually about seven days — and if their acute pain is not being managed within that timeframe, it can become a turning point. Treatment needs to be addressed at this point, or it can become problematic,” she says.

In the session, Ewing will also cover how to inform patients about opioid diversion and the proper ways to dispose of unused medication, as well as the need to screen patients for anxiety and depression, and evaluate their functionality at the start of the medication.

She will also review the nurse’s role in consistent assessment and documentation, educating the patient and family, providing empathy and nonpharmaceutical options to the patient, and ensuring the patient and family have a plan in place when the patient is discharged.

2 Responses

  1. Ana Seid says:

    I would love more information on this. Itís a common problem for me to take over a patient in the morning who has not received adequate pain control over night. Then it is a game of catch up in order to get them mobilized. In the very acute setting what is the optimal protocol to follow concerning IV and oral pain medication administration. Thank you for addressing this!

    • Alex Dingrando says:

      This is such an important topic given the current state of our healthcare system! I find this particularly relevant to the Cardiothoracic Surgery patients I typically encounter – in the facility in which I work a major issue is that generalized “pain management” policies do not take in to account the nature of the operation itself and the importance of pain control in preventing complications and improving outcomes. Pulmonary hygiene and early mobilization is paramount, however often difficult to achieve without adequate pain control. Unfortunately it seems the corporate-minded aspect of many healthcare institutions is becoming a barrier to optimizing patient outcomes. I believe wholeheartedly that bedside critical-care nurses should be included by administrators in the development of methods to manage pain in postoperative recovery given the concerns of the opioid crisis. Great topic, glad to see it being discussed!