Surgical Patient Compliance With Healthcare Facility-Provided In-home Opioid Disposal Products: A Systematic Review.

OBJECTIVE: The aim of this study was to review the literature regarding the use of an in-home opioid disposal product on unused opioids after surgery. BACKGROUND: The opioid epidemic in the United States is a major cause of concern for healthcare facilities. The misuse and diversion of retained opioids after a surgical procedure continues to contribute to this problem. METHODS: A comprehensive search of the Cumulative Index of Nursing and Allied Health Literature, OVID, and PubMed databases with keywords including opioid, analgesics, narcotics, medical waste disposal, medical disposal, refuse disposal, and opioid disposal resulted in 286 articles. Articles were screened based on strict inclusion and exclusion criteria. RESULTS: Eight studies determined that an in-home opioid disposal product provided by a healthcare facility produced rates of opioid disposal between 19% and 71%. CONCLUSIONS: The provision of an in-home opioid disposal product by a healthcare facility is likely to increase the disposal of unused opioid medications in the postoperative surgical patient population.

Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective.

BACKGROUND: Several studies have reported that working in a COVID-ICU impacted nurses' mental well-being. Yet little is known about how perianaesthesia nurses who have been working in a COVID-ICU perceived their stress of conscience. The aim of this study was to: (1) describe and compare stress related to troubled conscience among perianaesthesia nurses in three countries who have been working in a COVID-ICU during the pandemic, (2) compare their levels of troubled conscience between working in a COVID-ICU and their usual workplace, and (3) compare nurses that usually work in an ICU department with nurses who usually work outside of the ICU. METHODS: A descriptive, international cross-sectional online survey including the Stress of Conscience Questionnaire (SCQ) was distributed between organizational member countries of the International Collaboration of PeriAnaesthesia Nurses. RESULTS: A total of 246 nurses from three countries participated. Significant differences were found in stress of conscience when working in the Covid-ICU between Sweden 31.8 (8.6), Denmark 23.1 (8.6), and Netherlands 16.4 (6.5) p < 0.001. Significant differences were also found between nurses working in a COVID-ICU in contrast with their usual workplace: 23.1(5.6) versus 17.7(5.3), p < 0.001. The most stressful aspect of conscience reported was that work in the COVID-ICU was so demanding, nurses did not have sufficient energy to be involved with their family as much as they desired. No statistical differences were found between nurses that usually work in an ICU department with nurses who usually work outside of the ICU. CONCLUSION: The COVID-19 pandemic has negatively impacted stress of conscience among nurses working in the COVID-ICU. Swedish nurses were found to be more significantly impacted. This could be related to low numbers of existing ICU beds and ICU nurses prior to the pandemic necessitating a longer time required for working in a COVID-ICU. Stress of conscience also increased when working in the Covid-ICU compared to working in the usual workplace, and the most stressing aspect reported was that COVID-ICU work was so demanding that nurses did not have the energy to devote themselves to their family as they would have liked.

Compliance With Opioid Disposal Following Opioid Disposal Education in Surgical Patients: A Systematic Review.

PURPOSE: The present opioid epidemic in the United States is a significant cause for concern in healthcare. In 1995, the concept of pain was introduced as the fifth vital sign. Since then, the sales of opioids have increased dramatically, as have the number of opioid deaths. The misuse and diversion of retained opioids following surgical procedures contribute to the problem. The objective of this project was to review the latest scholarly work and evaluate the findings related to patient education and disposal of opioid medications to decrease opioid misuse and increase disposal. DESIGN: A systematic review. METHODS: The systematic search strategy included PubMed, Ovid Technologies (OVID), and Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases. FINDINGS: A total of 4 randomized controlled trials (RCTs), 2 quasi-experimental studies, and 2 quality improvement projects met the criteria for inclusion. The studies found that as many as 92% of patients had leftover unused opioids. The retention rate of opioids among surgical patients was found to be 33 to 95%. When educational material was provided about disposal, the studies found that the disposal rate was as high as 71%. CONCLUSIONS: Patient education about opioid misuse, diversion, and disposal are essential topics that need to be addressed with patients and caregivers.

A Web-based Educational Intervention to Increase Perianesthesia Nurses' Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids.

PURPOSE: The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education. DESIGN: A pre-test, post-test longitudinal design. METHODS: An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. FINDINGS: The participants were invited to complete a pre-test survey (n = 672), the immediate post-test (n = 245), and the 4-week post-test (n = 172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant. CONCLUSIONS: In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed.

Perianesthesia Patient Education for the Promotion of Opioid Stewardship.

Opioid overdose deaths and opioid use disorders are a crisis in the United States and other western countries around the globe. Opioid prescriptions more than doubled after the turn of the century, particularly for postoperative patients. Unfortunately, many who have abused opioids were able to obtain those opioids from friends or family who had held on to prescribed, but unused opioids. One method to manage and decrease the opportunity for unused opioids to become black-market opioids is to educate patients and families regarding the safe use, safe storage, and proper disposal of unused prescription opioids. Perianesthesia nurses, particularly those who educate patients before and after surgery, have an excellent opportunity to educate patients and families who are discharged to home after surgery.

Education, Competence, and Role of the Nurse Working in the PACU: An International Survey.

PURPOSE: The aim of this research project was to describe the education, competence, and role of nurses working in the postanesthesia care unit (PACU) in 11 countries having an established perianesthesia specialty nursing organization and membership on the International Collaboration of PeriAnaesthesia Nurses, Inc (ICPAN) Global Advisory Council (GAC). DESIGN: This is a descriptive international cross-sectional study. METHODS: A Web-based survey was distributed to members of the ICPAN GAC to be completed by the GAC representative or another expert perianesthesia nurse member from the organization (n = 11). The GAC has one representative from the following 11 ICPAN organizational members: ACPAN, Australian College of PeriAnaesthesia Nurses (Australia); BRV, Beroepsvereniging Recovery Verpleegkundigen (Belgium/The Netherlands); NAPANc, National Association of PeriAnesthesia Nurses of Canada (Canada); FSAIO, The Danish Association of Anaesthesia, Intensive Care and Recovery Nurses (Denmark); FANA, Finnish Association of Nurse Anaesthetists (Finland); Hellenic Perianesthesia Nursing Organization (Greece); IARNA, Irish Anaesthetic and Recovery Nurses Association (Ireland); PNC of NZNO, Perioperative Nurses College of the New Zealand Nurses Organisation (New Zealand); ANIVA, Swedish Association of Nurse Anesthetists and Intensive Care Nurses (Sweden); BARNA, British Anaesthetic and Recovery Nurses Association (United Kingdom); and ASPAN, American Society of PeriAnesthesia Nurses (USA). FINDINGS: Perianesthesia nursing was recognized as a professional nursing specialty in 6 of 11 countries, and 8 of 11 have established national guidelines or practice standards for perianesthesia nurses. The Netherlands, Ireland, and Australia are the only countries that have a formal education program for perianesthesia nurses. There were variations in nurse-to-patient ratios between the 11 countries, ranging from 2:1 to 1:3 in the Phase I recovery of critically ill patients; in Phase II recovery (day surgery) it was most common to have up to three to four patients per nurse. Perianesthesia nurses were mainly the only profession stationed in the PACU, with professions such as the anesthesiologist and surgeon on call. The nurses performed many job tasks autonomously; however, this differed between countries. CONCLUSIONS: Perianesthesia nurse education, clinical guidelines, other professions working in the PACU, and job tasks differ between countries. This knowledge can be used in international collaboration to further develop education and training for nurses working in the PACU. Continued international perianesthesia nursing partnership can only bring us closer and strengthen our specialty practice with the focus not on our differences but on our common denominators.

Perianesthesia Nurses' Knowledge and Promotion of Safe Use, Storage, and Disposal of Opioids.

PURPOSE: The purpose of this study was to determine perianesthesia nurses' knowledge and promotion of safe use, storage, and disposal of opioids to patients in the ambulatory surgery setting. DESIGN: A mixed methods descriptive survey. METHODS: Perianesthesia nurses who have responsibility for discharge education of patients after ambulatory surgery were eligible to participate. An evidence-based survey was e-mailed to all American Society of PeriAnesthesia Nurses members. A total of 1,977 nurses agreed to participate; 1,632 nurses met inclusion criteria and completed the survey. Responses to open-ended questions were coded and analyzed. FINDINGS: Perianesthesia nurses were generally knowledgeable about opioids and a large majority (82%) discuss side effects of opioids with every patient. A smaller percentage of perianesthesia nurses reported promoting safe use (27%), storage (23%), and disposal of opioids (18%) with every patient. CONCLUSIONS: Perianesthesia nurses have an opportunity to develop standard guidelines for patient education to uniformly promote postoperative opioid safety.

Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients.

PURPOSE: The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms. DESIGN: A qualitative descriptive study. METHODS: Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques. FINDINGS: Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress. CONCLUSIONS: Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.