Empowering Nurses: Communicating Potential Medication Misuse

BACKGROUND In nursing education and practice, we prepare nurses on topics such as patient care, pathophysiology, pharmacology, nursing leadership, and nursing competencies. Unfortunately, we may be missing the mark when it comes to integrating these topics and applying them to situations that arise in health care such as medication misuse. Nurses work intimately with patients and can recognize potential medication misuse by reviewing medication regimens and assessing necessity of PRN patient requests. In cases where nurses suspect misuse, they may or may not feel comfortable addressing these concerns with other members of the health care team. AIMS Study aims were to assess the baseline of whether nurses are comfortable with their level of skill to recognize potential patient medication misuse and to assess nurses’ comfortability with communicating these concerns with other nurses, providers, and patients. METHODS This survey study was designed to obtain practical information about nurses understanding of misused and diverted prescription medications and level of comfort with expressing concerns about the use of central nervous system depressants to inform education, practice, and research. Three-hundred and fifty nurses at one hospital were invited to participate in an anonymous REDCap survey. RESULTS Thirty-five percent of the surveyed nurses returned the survey. Responding nurses were more comfortable sharing their own knowledge and the need for more education on the topic than they were discussing interdisciplinary communication. CONCLUSIONS Empowering nurses to communicate this knowledge with others on the health care team has major public health implications to reduce the negative outcomes of misused medications.

Anti-spasticity medication and multiple sclerosis: why nurses and therapists need to get involved

Spasticity is common in people with MS and can negatively affect activities of daily living and quality of life. It can be managed with anti-spasticity medications, but prescribers often fail to titrate, monitor or review the efficacy of these drugs. Optimal doses are not always reached, and insidious side effects can cause symptoms that mimic disease progression, increase disability and hinder therapeutic interventions. It is important that health professionals involved in the management of people with MS are aware of the injurious potential of these medications and educate people with MS to self-manage them. This article looks at common anti-spasticity medications, the mode of action, dosage and side effects. It provides examples of how medication misuse can lead to increased disability and explains how neurological nurses and physiotherapists can play an active role in monitoring these medications as part of their treatment plan, including information on becoming an independent or supplementary prescriber.

Customizing CAT administration of the PROMIS Misuse of Prescription Pain Medication Item Bank for patients with chronic pain

Objective The 22-item PROMIS®-Rx Pain Medication Misuse item bank (Bank-22) imposes a high response burden. This study aimed to characterize the performance of the Bank-22 in a computer adaptive testing (CAT) setting based on varied stopping rules. Methods The 22 items were administered to 288 patients. We performed a CAT simulation using default stopping rules (CATPROMIS). In 5 other simulations, a “best health” response rule was added to decrease response burden. This rule stopped CAT administration when a participant selected “never” to a specified number of initial Bank-22 items (2-6 in this study, designated CATAlt2-Alt6). The Bank-22 and 7-item short form (SF-7) scores were compared to scores based on CATPROMIS, and the 5 CAT variations. Results Bank-22 scores correlated highly with the SF-7 and CATPROMIS, Alt5, Alt6 scores (rs=.87-.95) and moderately with CATAlt2- Alt4 scores (rs=.63-.74). In all CAT conditions, the greatest differences with Bank-22 scores were at the lower end of misuse T-scores. The smallest differences with Bank-22 and CATPROMIS scores were observed with CATAlt5 and CATAlt6. Compared to the SF-7, CATAlt5 and CATAlt6 reduced overall response burden by about 42%. Finally, the correlations between PROMIS-Rx Misuse and Anxiety T-scores remained relatively unchanged across the conditions (rs=.31-.43, ps < .001). Conclusions Applying a stopping rule based on number of initial “best health” responses reduced response burden for respondents with lower levels of misuse. The tradeoff was less measurement precision for those individuals, which could be an acceptable tradeoff when the chief concern is in discriminating higher levels of misuse.

Promethazine-induced delirium with perceptual abnormalities: are we thinking broadly when assessing patients?

There is limited information about promethazine-induced delirium with psychotic symptoms. The aim is to highlight the importance of taking a detailed history including medication use/abuse of both prescribed, illicit and over-the-counter preparations. This paper describes a patient who presented with delirium in the context of overuse of promethazine (Phenergan) which was initially missed. The patient was treated successfully, following the diagnosis of promethazine-induced delirium. Clinicians should be aware of assessing patients presenting with delirium to explore the possibility of over-the-counter medication misuse.