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2021 prov rn wa; 2021 prov rn poster; washington; spokane; pshmc




Background: Cellulitis is an acute infection of the skin resulting in acute pain and often requires pharmacological analgesics. Past studies revealed that more than half of patients receiving inpatient medical care in the United States received opioid analgesics for pain management during the hospital stay. While opioids are regarded as the strongest analgesic available to ease physical pain, these are habit-forming drugs that contribute to negative outcomes such as opioid use disorder and increased risk for accidental overdose and death. Recommendations for acute pain management in the hospital setting include prescribing less than 50 morphine milligram equivalents (MME's) per day to avoid negative outcomes. Although it is known that opioids should be administered at low doses to treat acute physical pain in the hospital, it is unclear how opioid administration practices have evolved over time to align with best practices in two acute care hospitals in the Pacific Northwest.

Purpose/aims: Our purpose was to evaluate how inpatient opioid administration evolved between the years 2014 and 2020 in two acute care hospitals for a model population with acute pain: adults with cellulitis.

Methods/Approach: Retrospective, de-identified data were extracted from the electronic health records for adults with a primary diagnosis of cellulitis. Records included in the analysis reflected patients age 18 years and older, hospitalized with cellulitis for at least 24 hours but no more than 7 days, treated at one of two hospitals in the Pacific Northwest between the years 2014 and 2020, and administration of an opioid medication during the encounter. Data were analyzed in Excel using descriptive and frequency statistics.

Results: A total of 3,413 inpatient records were included in the analysis. In this sample, adults who received high-dose opioids during the hospital stay were younger, more likely to have a documented substance use disorder, more likely to report taking an opioid within 30 days of the hospital encounter, and reported more pain than those who received low-dose opioids. The proportion of adults receiving high-dose opioids during the hospital stay for cellulitis decreased over time from 61% to 55%.

Conclusion: This project supports that opioid administration has evolved over time to align with best practice guidelines for alleviating acute pain. Future work is needed to further characterize what factors influence the strength of opioids administered in the hospital to manage acutely painful conditions such as cellulitis.

Implications for practice: Safe opioid prescribing is paramount to ensure effective short and long-term patient outcomes. It is important for nurses to advocate to prescribers to ensure all appropriate non-opioid analgesics and non-pharmacological pain management techniques are available to ease patient suffering as well as reduce high-dose opioid administration to avoid potential patient harms.



Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-based Practice Project

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