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

ABSTRACT

OBJECTIVE: To 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. DESIGN: Retrospective chart review of patients discharged during 6 months prior to and 6 months after introduction of the CNS role. SETTING: Not-for-profit 98-bed community inpatient rehabilitation hospital. PARTICIPANTS: Two population-based samples of adult, inpatient rehabilitation patients (N=72) with daily opioid use ≥30mg morphine equivalent dose (MED) per day on admission and length of stay ≥24 days. INTERVENTIONS: Implementation of a CNS pain consult program. MAIN OUTCOME MEASURES: Change in average daily opioid use (milligrams of MED per day), measured at admission, week 1, week 2, and week 3. RESULTS: Linear 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<.01), indicating faster change in opioid use for the CNS group (quadratic slope, -5.91) compared with the no CNS group (quadratic slope, -.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. CONCLUSIONS: Addition of a CNS 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.