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

Publication date: Available online 28 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michael S. Urton, Elaine Rohlik, Meagan Farrell, Wing Ng, Elizabeth K. Woodard
ObjectiveTo 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.DesignRetrospective chart review of patients discharged during six months prior to and six months following introduction of the CNS role.SettingNot-for-profit 98-bed community inpatient rehabilitation hospital.ParticipantsTwo 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.InterventionsImplementation of a CNS pain consult program.Main Outcome MeasuresChange in average daily opioid use (mg MED/day), measured at admission, Week 1, Week 2, and Week 3.ResultsLinear 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.ConclusionsAddition 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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