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Clinical Systems Leadership

The Rise of Overdoses: How Nurses Can Prepare

Nurses witness a wide variety of patient cases during their shifts. The goal is always to ensure people are taken care of in an effective and efficient manner when they enter a hospital or clinic – no matter their history or current condition.

Presently, the U.S. is experiencing an epidemic of drug overdoses, which are primarily caused by prescription and illicit opioids, according to the Centers for Disease Control and Prevention. These kinds of drugs account for 3 out of 5 drug overdose deaths and were responsible for the fatalities of over 33,000 people in 2015 alone.

As a result of these statistics and the growing number of cases involving overdose, nurses have to be prepared to treat patients struggling with addictions. There are a number of steps these clinicians can take to do just that.

Stock overdose-reversing drugs

Since opioids are the main cause of drug overdose death – and although the prescription versions are still widely used to provide pain relief – nurses need the appropriate resources to handle addiction cases. States including Massachusetts and Maryland have begun requiring school systems and nursing homes, among other facilities, to increase the number of overdose-reversing drugs they have on hand, according to The Boston Globe.

Naloxone, which is most well-known by the trade name Narcan, is an antidote for overdoses. The drug can quickly alleviate the respiratory distress of a patient who is overdosing. Naloxone now comes in a nasal spray, which costs around $100, and is relatively easy for just about anyone to administer, if necessary.

Nurses should have plenty of overdose-reversing injectable drugs.

Provide additional education

It’s not enough to simply stockpile naloxone for cases of drug overdose. Instead, nurses and other health-care providers need to understand the symptoms of these cases when they’re presented. It is crucial for clinicians to receive additional training on not only how to administer the overdose-reversing antidote, but on the following elements as well:

  • Identifying and treating patients with a history of substance abuse.
  • Understanding the stigma associated with this disease and addiction.
  • Providing options for substance abuse treatment for patients.
  • Offering rehabilitation to post-surgery cases also battling addiction.
  • Upholding the rights of people with substance abuse issues while also protecting other patients.
  • Legal monitoring of patients admitted with a substance abuse issue.
  • Supervision of visiting hours, especially if there is suspicion of illicit drugs entering the facility.

Clinicians walk a fine line in treating patients with addictions, but with a little extra guidance can prepare themselves to appropriately handle drug use and overdose.

Practice compassion

Every human being has his or her own challenges and setbacks to overcome during life. A person struggling with addiction is no different. Yet, it is not uncommon for these patients to be viewed differently in the eyes of society.

It is a nurse’s responsibility to look past the issue at hand and treat people with compassion, no matter what their condition. Maintaining a neutral attitude is crucial to these situations. Not only can negativity affect the willingness of the patient to accept medical care, but it can lead to missed opportunities to educate those with addictions about important and effective treatments, according to a study published in MEDSURG Nursing Journal.

Furthermore, caregivers may be less able to develop caring relationships with these patients if they act in a judgmental manner. This reduces their credibility as a health-care provider and the trustworthiness of certain treatments.

To handle these cases in the best way possible, nurses must not only remain neutral toward patients with addictions but provide evidence-based interventions. Showing people that clinicians see addiction as a mental disorder influenced by a number of factors, and offering further information about the disease, can work wonders in helping patients. The key is to ensure every person receives the care he or she needs when they visit a health care facility. No matter the nurse’s opinion, each patient should be treated with respect and compassion for the most effective treatment.

Create policy for identifying overdose

Ongoing education is crucial for clinicians, especially when it comes to overdose. Those situations stemming from opioids require special attention, as it can be difficult to tell the difference between an extreme high or an overdose.

Medical facilities need to develop their own policy and procedure for identifying and treating these dangerous instances. The Harm Reduction Coalition provides the following indicators for health-care providers to utilize when treating patients coming down from a high or experiencing an overdose:

High

  • Contracted, small pupils
  • Slack and droopy muscles
  • Nodding off
  • Itchy skin and scratching
  • Slurred speech
  • Responsive to outside stimulus

Overdose

  • Loss of consciousness
  • Slow and shallow breathing
  • Limp body
  • Unable to talk, even if awake
  • Unresponsive to outside stimulus
  • Erratic or stopped breathing
  • Choking sounds or snore-like gurgling noise
  • Vomiting
  • Pale or clammy face
  • Slow, erratic or missing pulse
  • Blue or purplish-black fingernails and lips
  • Skin tone turns bluish purple (for lighter-skinned people) or grayish/ashen (for darker-skinned people)

A quick response to these symptoms is critical to a successful outcome. Immediate death from an overdose is not a regular occurrence, but survival is tied directly to the presence of another person who can recognize signs of a larger problem at hand.

Study for an advanced degree

While the role of a nurse is important no matter their level of education, there are certain benefits to gaining a higher education and degree. Those who receive a master or doctoral level certification earn the title of Advanced Practice Registered Nurse and have the opportunity to provide more in-depth care for their patients. For patients with substance abuse problems, having these licensed health-care professionals on their side is extremely helpful.

APRNs are able to prescribe different medications and offer assessments, education and other treatment options to patients with addictions. Once APRNs reach this level of certification, it’s important for them to stay updated on legislation that could greatly aid their substance abuse cases.

One example of legislation is surrounding the ability to utilize Suboxone, a medication-assisted treatment which combines Naloxone and Buprenorphine, which has been proven to be effective for patients suffering from addictions. Currently, only qualifying physicians are able to prescribe this type of medication but the Recovery Enhancement for Addiction Treatment aims to change the term “qualifying physician” to “qualifying practitioner,” which would enable APRNs – with certification – to prescribe Suboxone to patients. Although the bill has been presented to Congress, no action has been taken as of yet.

This legislation could change the way health-care providers help patients struggling with addiction and increase access to medication-assisted treatments. Gaining an advanced degree will put nurses one step closer to the qualifications necessary if and when this legislation is passed in some capacity. At the very least, clinicians should try to remain informed on this bill and its effects on their practice – now and in the future.

An advanced degree will give clinicians the skills necessary to be able to identify and treat an overdose.

Understand the high-risk statistics

While being able to identify an overdose is an educational step all nurses must learn, there is more to addiction than that. Not only do clinicians have to aim to prevent new cases of substance abuse from starting, but these health-care providers are also responsible for treating patients who are already addicted.

To ensure they are informed, clinicians need to understand the statistics surrounding high-risk persons, states and communities. Not only are patients with mental illness or a history of substance abuse more likely to have a problem, but so are the populations dependent on Medicaid, patients from low-income households and those living in rural areas.

Additionally, certain states are prone to substance abuse due to a variety of factors. The jurisdictions with the highest rate of death due to drug overdose in 2015 include West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island, according to the CDC. The federal agency also reported that the largest increases in drug-related overdose deaths occurred in the Northeast and South Census regions.

Clinicians play a large role in assisting patients with addictions. Whether treating a substance abuse problem or aiding a person experiencing an overdose, there are many steps nurses can take to help. Yet, preparation is key for a positive outcome. With a strong supply of overdose-reversing drugs, additional education about addiction and the ability to offer compassion, among other things, health-care providers can ensure all of their patients are treated fairly and with respect.

Overdose-related deaths can be prevented if clinicians have access to the necessary drugs, information on treatment and education on the proper care of patients with addictions and substance abuse issues.

A Master’s of Science in Nursing  from the University of Arizona can give you the tools to help patients dealing with addiction.

Sources

https://www.bostonglobe.com/metro/2016/11/29/nursing-homes-urged-stock-overdose-antidote-train-staff-addiction-care/fTVxhig5Qo0NvhVUztESLM/story.html

https://www.cdc.gov/drugoverdose/data/statedeaths.html

https://www.cdc.gov/drugoverdose/data/index.html

http://www.baltimoresun.com/news/maryland/education/bs-md-narcan-schools-20161102-story.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070513/

http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose/

https://www.congress.gov/106/plaws/publ310/PLAW-106publ310.pdf

https://www.govtrack.us/congress/bills/114/hr2536/text

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