The U.S. opioid epidemic continues to rage. The national rate of opioid-related emergency department (ED) visits increased 99 percent from 2005 to 2014. Inpatient stays increased 64 percent.
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In 2016, EDs in Cuyahoga County (Ohio), where Cleveland Clinic is based, treated an average of more than 20 patients per day with drug-related injuries. More than 500 victims died. That’s double the number from 2015. Numbers for 2017 are expected to double again.
“Our caregivers have been dealing with the opioid epidemic for years, but we don’t believe it has peaked yet,” says Jennifer Johns, Director of Government Relations at Cleveland Clinic.
In response, Cleveland Clinic launched an opioid task force of close to 200 thought leaders from all areas of the organization, including clinical, administration and business operations. Johns is the chair.
Nurses were particularly motivated to participate, since they are on the front lines of caring for overdose victims, says Meredith Lahl-Foxx, MBA, MSN, APRN, Executive Director and Associate Chief Nursing Officer of Advanced Practice Nursing at Cleveland Clinic.
“Our Nursing Legislative and Health Policy Council also has been focusing on the opioid crisis,” she says. “Nurses in that group were given an opportunity to participate in the organization-wide opioid task force.”
Nurses on the front lines
Lahl-Foxx praises the nation’s growing addiction prevention efforts, but nurses need support to handle the acute crises that are still happening, she says.
“Burnout is a real problem for nurses who care for patients with opioid addiction. We have patients that end up in our EDs time and time again. We’ve had visitors sneak drugs in for patients. Nurses walk a fine line of trying to be empathetic and caring, while enforcing boundaries that keep patients safe.”
Stress on the job is only half the problem. Lahl-Foxx says nurses are conflicted about how to help people with addiction that they encounter when not at work. How much responsibility do they have?
“People expect nurses to have information and resources,” she says. “What is the role of nurses when they see someone who has overdosed in a parking lot, for example? There are many unanswered questions.”
Task force efforts
Because the opioid crisis is top-of-mind for nurses, several, including Lahl-Foxx, volunteered to represent their colleagues on the opioid task force, which began meeting in early 2017. Nurses participate in all three focus areas:
- Clinical care. This group studies opioid prescribing patterns and how to treat the addicted population. Nurses have been most involved in implementing a care path to identify and manage addicted obstetric patients before, during and after birth.
Other projects include:
- Developing alternatives to pain medication. For example, instead of prescribing opioids, caregivers can enroll patients with chronic back pain in a 12-month program combining physical therapy and behavioral medicine.
- Updating and clarifying discharge instructions and facilitating follow-up appointments for patients who came in due to an overdose.
- Health policy. Efforts include:
- Advocating for a new law to make naloxone more widely available, specifically expanding the scope of practice for pharmacists to dispense it, and preventing criminal prosecution of people who seek emergency medical care for those who have overdosed.
- Working with state lawmakers to identify funding for the opioid epidemic as part of legislation to encourage pregnant women with addiction to get treatment. The bill allows women up to 20 weeks pregnant to come forward to seek treatment and, if they complete or remain in treatment, avoid having their addiction used against them in child custody matters.
- Education and prevention. “Nurses have really taken the lead in helping shape our education and prevention efforts,” says Johns. They are predominantly involved with:
- Caring for Caregivers. This program educates caregivers on addiction, teaches strategies for handling addicted and/or manipulative patients, and presents ways to combat “compassion fatigue.”
- Community education. Nurses lead informational sessions at libraries, churches, schools and community centers about the dangers of opioids. More nurses have stepped up to join Cleveland Clinic’s speaker’s bureau in light of the opioid crisis.
Easing the burden of care
“If a friend brings a patient heroin while he’s in the ED, what should a nurse say? What should a nurse do?” asks Lahl-Foxx. “The task force is rising to challenges like this and developing guidance.”
All three focus areas will have a direct effect on nurses — providing training, resources or other support to ease the burden of caring for patients with addiction. They also will help keep patients safer, says Lahl-Foxx.
“Addiction affects all types of people in all types of communities,” she says. “We need to empower nurses with the resources and support to manage it. Their involvement with the task force already shows how willing they are to step up to address the opioid crisis.”