Episode 5: The Role of the Surgical Nurse in Opioid Stewardship

Christine Schleider: Thank you, Judy, Kathy, and Lee, for being here today. I appreciate the opportunity to get together and talk about this very important topic of surgical opioid stewardship. The climate today around surgical prescribing is so different than it was when we all started as nurses. As surgical nurses, we were the ones who took care of patients before surgery and after surgery, and who prepared them for surgery. We were involved in all phases of patient care. And, we helped treat their pain. So, let’s think about opioid stewardship now, in 2022. I think we’ve all struggled with patient communication at times, during our careers. For this surgical opioid stewardship program, we’ve developed different brochures. There are videos we can show to patients. Can we talk a little about patient communication? Especially when we’re short on time, what’s the best way to get a message across to a patient?   Lee Holman: Having the surgeon tell them. If the surgeon sets the expectation, that's sort of the highest bar, the gold standard.   Judith DellaPorta: And I also think having a family member there when you discuss pain management. We've all been there where the patient's yelling in pain, the family member is yelling at you… So, if the family knows ahead of time that it's not going to be perfect post-op, but we're going to try and do everything we can to manage this, I think they can reinforce to the patient sometimes that you'll get through this.   Kathleen Shindle: That's so true. I think in that pre-op education with the family involved and also maybe setting some guidelines such as, "I'd like you to walk today every day before surgery for 30 minutes," or "I'd like you to do this." So that you have some kind of guideline, not just to say, "Okay. I want you to walk more or I want you to do what do you normally do." And asking a patient, "What can you do that you think that could increase your mobility?" and then say, "Well, do you think you could walk maybe 30 minutes today?" And go from there. And I also always like the statement, "And I also want you to bring your sneakers.” So that way that gives that patient the thought in their mind, "Oh yeah. I got to get up out of bed. As soon as I have my surgery… that's a good thing they're going to expect me to get up."  I think you have to really weigh how we say to a patient, "You're going to have pain." Try to make it more... Turn that into more of a positive, right? "You might have some pain. This is what you can do to...   Christine Schleider: A lot of patients and even people that I know and family members, when they need to have a hip replaced or a knee replaced, they put it off for so long because they're so afraid of the pain that they're going to have afterwards. And so many people always say afterwards, "I shouldn't have waited this long. I should have done it sooner."   Lee Holman: Yep.   Judith DellaPorta: And I think with the advent of minimally invasive surgery, that's just going to get better and better and better and better. So hopefully, pain won't be as difficult to control for these patients.   Christine Schleider: So, what we’re talking about here is communication and honesty.   Judith DellaPorta: I think it's important to have a conversation even preoperatively in the surgeon's office and be open and honest with them that, "You will have pain. We will try our best to relieve it to the best of our capabilities." And, you're working as a team, and you're going to help them get through this. I think that supports them and gives them some confidence going into the surgery.   Christine Schleider: Judy, I agree. Pre-op, I think, is very important to reach out to a patient or even at the time of getting ready for surgery in the surgical clinic… having a whole conversation and education session about the expectations of pain. You're going to have discomfort, but you're going to be able to do all the things that you need to do to help you recover."   Judith DellaPorta: I think the appendectomies, the choles, they really come down on our opioid discharge medication. But patients that have major abdominal surgery, major vascular surgery, they have acute pain and it needs to be relieved. So, I think we have to look at this individually—you have to look at every patient. They're all different. They’re not just a surgical patient. So we have to take a lot into consideration and make sure that they are getting what they deserve.   Kathleen Shindle: And knowing their history. I think we all need to know, "Does this patient have a history of opioid use or abuse and is pain service on board? Is this someone that maybe should have a pain consult prior to surgery?"   Judith DellaPorta: I know what we're doing here is anybody who's opioid tolerant is seeing anesthesia preoperatively, and they're making up a plan for the postop care. And I remember when I was a PACU nurse, we dreaded getting an opioid-tolerant ...