RESUMEN
BACKGROUND: Every day, more than 190 people in the United States die from opioid overdose. Unused opioid medications pose a risk to the patient and the community as they increase the potential for abuse or misuse. A contributing factor is lack of education on the proper disposal methods of unused opioid medications. PURPOSE: The purpose of this quasi-experimental nursing study was to examine whether providing education on proper disposal of opioid medications would increase the proportion of patients who properly dispose of unused opioids. METHODS: The study site's mandatory orthopaedic preoperative class was used for consenting patients. The control group did not receive targeted education on opioid disposal, whereas the intervention group did receive targeted education. A total of 86 patients were consented during Months 1 and 2 of the study. Forty-one patients were in the control group and 45 were in the intervention group. Demographic variables such as age, gender, and marital status were collected to determine whether certain demographic factors had an influence over whether or not opioids would be disposed of properly. FINDINGS: Those in the intervention group who attended the class were slightly younger than those in the control group (68.2 ± 9.9 years vs. 70.3 ± 10.6 years, p = .5098), primarily male (57.5% vs. 35.0%, p = .0436), and more likely to live with a significant other (94.7% vs. 74.4%, p = .0249). Of those who had medication left over, 62.5% disposed of their unused opioid prescription in the intervention group compared with 40.7% in the control group (p = .1208). In the intervention group, 86.7% of the individuals with leftover medication disposed of it correctly compared with 63.5% in the control group (p = .3478). CONCLUSION: Those who received education on appropriate opioid disposal were more likely to dispose of it in general as well as dispose of it correctly. Although not statistically significant, the findings from this study are clinically significant in that they provide direction on the importance of standardized and focused patient education on proper opioid disposal.
Asunto(s)
Analgésicos Opioides , Eliminación de Residuos Sanitarios , Anciano , Analgésicos Opioides/efectos adversos , Femenino , Humanos , Masculino , Estados UnidosRESUMEN
Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.
Asunto(s)
Delirio/diagnóstico , Hematología , Pacientes Internos , Tamizaje Masivo , Ortopedia , Triaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermería Ortopédica , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
: The competing demands of caring for high-acuity patients, reducing health care costs, and improving access to specialty care are complex challenges facing all health care providers. One approach-empowering nurses to expand their scope of practice-has been successfully employed for two decades by the nurse and physician leadership of a neurology department in an urban academic medical center. This article discusses the department's implementation of a quality improvement initiative to enhance access to neurology services in an ambulatory clinic by extending nursing practice to include lumbar puncture. Outcomes data from 2005 to 2016 demonstrate that through the department's comprehensive instructional program, RNs have competently and safely acquired new skills that have led to an expansion of their traditional roles, improved patient access to specialty care, and reduced costs.