Reflection on the “Pathways to Safer Opioid Use” interactive exercise
The Pathways to Safer Opioid Use interactive exercise demonstrates how decisions made by medical workers influence the use of opioids by patients (“Pathways to Safer”, 2017). From the practice, I concluded that effective interactions with patients could prevent opioid-related adverse drug events. Therefore, it is essential to communicate with patients about alternative treatment options, explain to them that opioids are often not the first choice, and come to a shared decision about the treatment.
As a prescriber, I believe that pain management should be done with the considerations of all possible outcomes and with the appropriate use of screening tools. Chronic pain management is a long, systematic process, and the goal of a prescriber is to make sure that patients understand all aspects of it. Previously, I did not have cases of misuse of painkillers or with patients who tried to get a high dosage of pain medications. This interactive helped me know more about pain management and associated risk factors.
To protect patients and me against opioid misuse, I need to be more careful about a patient’s mental and physical health and make sure that he understands shared information correctly. For example, James Parker from the interactive had signs of depression due to the constant back pain (“Pathways to Safer”, 2017). Hence, having shared decision-making is the best option to positively approach and motivate the patient, as he is involved with his treatment and sets long-term goals. A positive attitude along with a good understanding of risk factors would prevent James Parker from opioid misuse.
I should also communicate with a patient to know if he has relatives or friends who suggest them to use opioid drugs and explain potential side effects of misusing them. For example, Janet Martinez was told by his mother to have painkillers due to her ankle pain (“Pathways to Safer”, 2017). A doctor can understand whether patients have patterns to misuse opioid through conducting open communication.
Furthermore, the doctor should provide screening to detect potential misuse of drugs. After contact and screening, it is also essential to consult with other medical workers related to the patient to his response to the provided treatment. For example, in the case of 38-year-old Kara, who has sickle cell anemia, consultation with her hematologist was an excellent decision to prevent pain medication prescription (“Pathways of Safer,” 2017). This demonstrates the importance of communication and screening in pain management.
Case
Shar is a 28-year-old female active golfer who fell down the stairs last week and presented to the office three days ago with a high-grade sprain of the right ankle diagnosed by the orthopedist. Today, she reports to you that her ankle is painful, tender, and swollen. She had difficulty ambulating after playing a round of golf with her friends yesterday. What is your treatment plan for Shar, and why? What clinical guidelines support your decision? What patient education should you give to Shar?
Solution
Shar is an active golfer with a high-grade sprain of the right ankle. Ankle injuries, particularly ankle sprains, are a common occurrence in sports and may be harmful to the professional career of athletes. The treatment goals should include reducing the pain and swelling, restoring ankle functioning and healing. There are over-the-counter pain medications like ibuprofen, naproxen sodium (e.g., Aleve), or acetaminophen (e.g., Tylenol) to reduce pain.
These medications should be enough, and no more painkillers are needed. I also would recommend an ankle brace treatment, as it was investigated that such treatment provides more favorable outcomes than other methods and is more cost-effective (Doherty et al., 2017). Therefore, an ankle brace treatment is an effective method in that case. Moreover, the R.I.C.E. approach that includes rest, ice compression, and elevation would be prescribed as a reasonable intervention in the high-grade sprain of an ankle (Chen et al., 2019). Along with the R.I.C.E. method, it is also helpful to have electrical stimulation to reduce pain.
To have open communication with Shar, I will apply health literacy strategies to create a welcoming attitude and make the patient comfortable. Following that, I will explain to the patient that self-care based on the principle of R.I.C.E. is needed and that she should follow all the instructions provided by her orthopedist and me. Furthermore, I will explain that the treatment is long and requires a systematic approach and patience.
I should also clarify that the pain will not always be acute and that it will be relieved by following instructions. Due to the acute pain, the patient may ask for high-class pain medications like opioid drugs. Therefore, I should convey that it is not the first choice in pain management and that several alternative treatments reduce the pain. I should be honest with Shat and explain potential risk factors related to painkillers, changes during recovery, and medicine.
I will apply the teach-back method to ensure that Shar understands all relevant information and knows what to do. Providing patient education and explaining the importance of on-time treatment makes treatment effective and reduces future injuries (Vuurbeg et al., 2018). In addition, I will have shared decision-making with Shar to allow her to express her thoughts, fears, or suggestion about her treatment. Shar is an active golfer who cannot play, so shared decision-making also helps to evaluate her mental health and attitude towards treatment.
References
Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle sprains: Evaluation, rehabilitation, and prevention. Current Sports Medicine Reports, 18(6), 217-223.
Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), 113-125.
Pathways to Safer Opioid Use. (2017). Health. Web.
Vuurberg, G., Hoorntje, A., Wink, L. M., Van Der Doelen, B. F., Van Den Bekerom, M. P., Dekker, R.,… & Kerkhoffs, G. M. (2018). Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15), 956-956.