Bold Voices - August 2017 - 15

AT THE BEDSIDE

Studies Provide Insights Into
Reducing Opioid Use

T

wo studies regarding
opioid use among adults
and youths offer insights
into ways healthcare professionals can reduce the U.S.
opioid crisis.
"Characteristics of Initial
Prescription Episodes and
Likelihood of Long-Term
Opioid Use - United States,
2006-2015," in Morbidity and Mortality Weekly Report, finds
the risk of chronic use increases with each additional day
of opioid therapy, starting with the third day and rising
most sharply after five days or after one month of use.
"Discussions with patients about the long-term use of
opioids to manage pain should occur early in the opioid
prescribing process," the study explains, adding that one
in seven people who received a refill or had a second
opioid prescription authorized were still taking opioids a
year later.
Likewise, restricting access by children and teens is
another important prevention strategy, according to a
study in Pediatrics. "Prescription Opioid Exposures Among

Children and Adolescents in the United States: 2000-2015"
states that dosing correctly and asking parents to safeguard
prescription opioids and safely dispose of unused medications are helpful measures.
The study examined 188,468 prescription opioid exposures reported to U.S. poison control centers for youths
younger than 20, finding that exposures increased 86
percent from 2000 to 2009 and fell about 30 percent from
2009 to 2015.
"While overall rates of exposure to opioids among
children are going down, they are still too high," study
co-author Gary Smith, Nationwide Children's Hospital,
Columbus, Ohio, says in a related article in The Huffington
Post. "We need to continue to examine our prescription
practices and to increase education to parents about safe
ways to store these medications at home to keep them out
of the hands of children."
REFERENCES:
1 Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and
likelihood of long-term opioid use - United States, 2006-2015. MMWR Morb Mortal
Wkly Rep. 2017;66(10):265-269.
2 Allen JD, Casavant MJ, Spiller HA, Chounthirath T, Hodges NL, Smith GA. Prescription
opioid exposures among children and adolescents in the United States: 2000-2015
[published online March 20, 2017]. Pediatrics. doi:10.1542/peds.2016-3382.

Short-Term Oral Corticosteroids
Increase Risk of Adverse Effects
Clinicians should
understand the potential
risk, carefully evaluate
the necessity of the
medication and give the
smallest amount possible
to treat the conditions.

P

atients taking short-term doses of oral corticosteroids have an increased risk of
fractures, venous thromboembolism (VTE) or sepsis in the months following
treatment.
According to "Short Term Use of Oral Corticosteroids and Related Harms Among
Adults in the United States: Population Based Cohort Study," in BMJ, the number of
patients with these adverse effects is small but statistically significant even at the lowest
doses. Five conditions made up half of the corticosteroid prescriptions: upper respiratory
tract infections, spinal conditions, intervertebral disc disorders, allergies, bronchitis and
(non-broncitic) lower respiratory disorders.
Using anonymous private insurance data for over 1.5 million American adults 18 to
64 years old over a three-year period (2012-2014), the retrospective study determined
that 327,452 (21.1 percent) "received at least one outpatient prescription for short term use of oral corticosteroids
over the three year period. Use was more frequent among older patients, women, and white adults, with significant
regional variation," adding that within 30 days of drug titration, there were increased rates of sepsis, VTE and fracture, which decreased over the next 31 to 90 days.
"We need to understand that steroids do have a real risk and that we may use them more than we really need to,"
lead author Akbar Waljee, assistant professor of gastroenterology at University of Michigan Medical School, says in a
related article in Science Daily. The study recommends clinicians understand the potential risk, carefully evaluate the
necessity of the medication and give the smallest amount possible to treat the conditions.

REFERENCE: Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ.
2017;357:j1415. doi:10.1136/bmj.j1415.

15
AACN BOLD VOICES AUGUST 2017

Two new studies
suggest ways
healthcare
professionals can
reduce the U.S.
opioid crisis.


http://pediatrics.aappublications.org/content/early/2017/03/16/peds.2016-3382 https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w http://www.huffingtonpost.com/entry/with-a-few-exceptions-opioid-exposure-among-kids-and-teens-falls_us_58d17555e4b0be71dcf8b9d6 http://www.huffingtonpost.com/entry/with-a-few-exceptions-opioid-exposure-among-kids-and-teens-falls_us_58d17555e4b0be71dcf8b9d6 http://pediatrics.aappublications.org/content/early/2017/03/16/peds.2016-3382 http://www.bmj.com/content/357/bmj.j1415 http://www.bmj.com/content/357/bmj.j1415 https://www.sciencedaily.com/releases/2017/04/170413095037.htm

Table of Contents for the Digital Edition of Bold Voices - August 2017

Another Angle
Pres Note Front Teaser
Masthead
New Online Toolkit Shows Crucial Roles of Nurses in Serious Illness Communication
Oct. 31 Deadline to Apply for AACN Research Grants
PCCN or CCRN: Which Certification Is Right for You?
Failed Resuscitations May Increase Stress for Nurses
Updated Cardiac Nursing Course and CMC Review Course Online
New Behavior-Based Pain Assessment Tool
Hospital Rooftop Is a Hive of Activity
Former ICU Nurse Collects 100K Objects for Medical Mosaic
Interventions Reduce Wrong-Patient Orders in NICUs
Increasing Acceptance of Pediatric Telemedicine
The Privilege of Nursing
Effects of Dexmedetomidine
Seizure Risk Much Higher for Sepsis Survivors
Studies Provide Insights Into Reducing Opioid Use
Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Hospital Staff Becoming Product Innovators
Addressing Barriers to APRN Practice
Survival Rates Higher During Joint Commission Surveys
Effect of Rudeness on Pediatric Team Performance
Glasgow Coma Scale Stands the Test of Time
ECRI Introduces Patient Identification Tools
Reducing Risk Factors in Pediatric Delirium
Bundle Compliance Increases Survival, Reduces Delirium
Fostering Resilience in Healthcare Professionals Who Are Also Moms
Members: Enhance Your Career With an AACN Scholarship
In Our Journals
Transitions
President’s Note
Bold Voices - August 2017 - Cover1
Bold Voices - August 2017 - Cover2
Bold Voices - August 2017 - Pres Note Front Teaser
Bold Voices - August 2017 - Masthead
Bold Voices - August 2017 - Oct. 31 Deadline to Apply for AACN Research Grants
Bold Voices - August 2017 - PCCN or CCRN: Which Certification Is Right for You?
Bold Voices - August 2017 - 7
Bold Voices - August 2017 - Updated Cardiac Nursing Course and CMC Review Course Online
Bold Voices - August 2017 - New Behavior-Based Pain Assessment Tool
Bold Voices - August 2017 - Former ICU Nurse Collects 100K Objects for Medical Mosaic
Bold Voices - August 2017 - Increasing Acceptance of Pediatric Telemedicine
Bold Voices - August 2017 - The Privilege of Nursing
Bold Voices - August 2017 - 13
Bold Voices - August 2017 - Seizure Risk Much Higher for Sepsis Survivors
Bold Voices - August 2017 - Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Bold Voices - August 2017 - Addressing Barriers to APRN Practice
Bold Voices - August 2017 - Effect of Rudeness on Pediatric Team Performance
Bold Voices - August 2017 - ECRI Introduces Patient Identification Tools
Bold Voices - August 2017 - Bundle Compliance Increases Survival, Reduces Delirium
Bold Voices - August 2017 - Members: Enhance Your Career With an AACN Scholarship
Bold Voices - August 2017 - Transitions
Bold Voices - August 2017 - President’s Note
Bold Voices - August 2017 - Cover3
Bold Voices - August 2017 - Cover4
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