Capstone Project Change Proposal

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

Part of this team are pharmacy interns who distribute naloxone (Narcan) rescue kits to the patient every saturday morning. The naloxone rescue kits were donated by the Steve Rummler Hope Foundation. The Steve Rummler Hope Foundation partnered with HCMC with a mission to heighten awareness of the dilemma of chronic pain and the disease of addiction and to improve the associated care process.4 The pharmacy intern spends about fifteen minutes educating the patients on signs and symptoms of opioid overdose, how to respond and how to use the naloxone rescue kits. This program has been successful with distribution of a total of 150 kits as of October of 2016. In addition, patients often provide success stories of occasions when they saved the lives of a loved one or a friend using the naloxone rescue

The use of opioids and other drugs continues to gradually increase in the United State. According to Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids has quadrupled since 1999” (CDC website). Individuals are abusing prescription opioids such as oxycodone, hydrocodone, and methadone. Prescriptions opioids that are supposed to be used as pain relievers, cough suppressants and for withdrawal symptoms are being use by individuals in order to feel relaxed or for the overwhelming effect of euphoria. These types of drugs are to be taken orally, but people are snorting, smoking, and injecting them in order to get a better high. I have personal encounters with opioid drugs and opioid abuser on a regular

Last year there were over 64,000 reported opioid-related deaths in the United States – making it the leading cause of accidental death in people under the age of 50 in this country (Katz). Opioids, also referred to as painkillers, have become a growing problem over the past two decades particularly in rural communities all across the country where the death rates are higher per capita compared to the death rate in cities (“America’s Opioid Epidemic is Worsening”). These narcotics, such as codeine, fentanyl, hydrocodone, morphine and oxycodone are extremely addictive and, as a result, this silent killer has quadrupled the overdose death toll since 1999

Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865).

In Nolan and Amico’s article, “How Bad is the Opioid Epidemic?” they argue the opioid epidemic has become the worst drug crisis in American history. Heroin and other opioids overdose kill more than 47,055 people a year. Deaths caused from drug overdose has outnumber as much as 40 percent compared to the death caused from car crashes in 2014 (Nolan and Amico 3). Furthermore, in 1999 there were only 15000 people died from drug overdose. This number has tripled in 15 years. Also, in his article, “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse” Volkow also presents the fact that “with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise. For example, the number of unintentional overdose deaths from prescription pain relievers has

Nurses, especially nurses working on an Addiction Medicine unit, are well-positioned to provide patient and family education on opioid addiction (Manworren, 2015; Painter, 2017). Effective patient and family education can theoretically improve the capacity for patients at risk for opioid dependence and/or patients experience opioid dependence to cope with the problem, reduce risks, and prevent relapse (Costello et al., 2016; McNeil et al., 2015). Nurses working on an inpatient unit provide patient education as part of regular daily care and during the course of discharge planning and management (Costello et al., 2016). Patient and family education related to the patient’s diagnosis and/or reason for admission is standard practice on most units. However, nurses, including nurses working on an addiction treatment unit, may lack sufficient knowledge in opioid addiction prevention and management to provide suitable patient-centered education to patients and their families (Costello et al., 2016). Moreover, there is currently no established model or protocol for nursing-directed patient and family opioid addiction education (Costello et al., 2016; Manworren,

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

It is no secret that the United States is currently experiencing a shortage of nurses . “The U.S. Department of Labor, Bureau of Labor Statistics ( 2009 ) estimated that more than one million new and replacement nurses will be needed by 2018 to meet the increased demands of the health care workforce” (). The stressful conditions under which nurses work, due in part to the nursing shortage, are among the risk factors that contribute to nurses’ abuse of illicit drugs and alcohol. Nurses are unique in that they work in an environment where they not only have access to controlled substances, but also are exposed to critically ill patients, traumatic situations, death and dying, the stress of which can increase the risk of substance abuse. (Epstein, Burns, & Conlon, 2010). Unfortunately, it is the patient that suffers the most.

America has a major problem with opioid addicts, and many facilities are helping the addicts by providing safer options to taking the drugs their bodies crave. Methadone clinics are places where people addicted to opioids can receive medicine-based therapy. Opioid use, drugs such as heroin, morphine, and prescribed painkillers, has increased in the US with all age groups and incomes. People become addicted to these drugs when they are prescribed, recreationally used with other addicts, or they are born addicted. Many health institutions are addressing this issue with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

Prescription opioid misuse has emerged as a significant public health issue in the United States. Since the late 1990s, nationwide sales of prescription opioids have risen 4-fold, and with this, the rate of admissions for substance use treatment and the rate of death from opioid overdose have grown proportionately.1

Changes within healthcare are an essential component in quality and improvement. Organizational changes in the healthcare setting are most often implemented to (a) increase safety, (b) reduce wait times and delays, (c) increase the reliability of care, (d) reduce the cost of care, and (e) lastly to focus on patient centered care. Nursing theories are the result of nurses seeking to improve disparities and generate further nursing knowledge used in practice.