About Diane Szulecki

Editor, American Journal of Nursing

A Closer Look at the Joint Commission’s New Guidelines for Pain Assessment and Management

Photo © Burger / Phanie / Science Photo Library.

Starting on January 1, 2018, the Joint Commission’s new and revised pain assessment and management standards for accredited hospitals will go into effect. Notably, the guidelines—as we report in a November news article—address safe opioid prescribing practices.

Among new requirements, the Joint Commission says hospitals should:

  • Designate a leader or team responsible for pain management and safe opioid prescribing.
  • Include patients in developing a pain management treatment plan—including realistic expectations and measurable goals—and educate them on discharge plans related to opioid adverse effects and safe use, storage, and disposal of opioids.
  • Use prescription drug monitoring program (PDMP) databases to identify patients at risk for opioid addiction.
  • Identify opioid addiction treatment programs for patient referrals.
  • Inform staff about consultation and referral services available for patients with complex pain management needs.
  • Collect and analyze data on pain assessment and management to identify areas in which safety and quality could be improved.

The full list of new and revised guidelines is available here. How might these changes affect life for nurses and patients? Comments are welcome below.

2017-11-17T08:48:30+00:00 November 17th, 2017|Nursing, pain management, patient experience|0 Comments

AJN in November: Preeclampsia Management, Health Conditions Associated with Military Service, More

The November issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Preeclampsia: Current Approaches to Nursing Management

A clinical review of current practice related to preeclampsia risk assessment, prediction, and management, plus updated diagnostic criteria from the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy.

CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD

Evidence shows that veterans who receive their health care from private sector employers are less likely to be screened for military service—and therefore may not be treated for service-related health conditions. Here, the authors explore whether rural Pennsylvania providers offer this screening to their patients.

Creating a Fair and Just Culture in Schools of Nursing

What strategies can nursing schools use to create a fair and just culture? The second part in a two-part series.

Perspectives on Palliative Nursing: Liberty and Justice for All 

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

There’s much more in our November issue, including:

  • Teaching for Practice column on promoting nursing students’ ethical development
  • An AJN Reports on recent legislation to […]
2017-10-30T09:25:26+00:00 October 30th, 2017|Nursing|0 Comments

High Opioid Overdose Numbers Spur State, City Initiatives

State 2015 overdose death rates compared with national rate. (CDC image)

As we report in an October news article, recent studies have shed light on the growing scale of the opioid crisis in the United States. Among the latest statistics:

  • 33,000 Americans died in 2015 from an opioid overdose, a high percentage from the use of synthetic opioids such as illegally manufactured fentanyl.
  • The diagnosis of “opioid use disorder” climbed 493% from 2010 to 2016 in Blue Cross Blue Shield claims.
  • Around 4.31% of Americans ages 12 or older use prescription pain relievers for nonmedical uses.

Increasing Naloxone availability.

The findings underscore the urgent need to take steps to combat the crisis—a need that has prompted states and cities to attack the issue using various methods. Baltimore’s health commissioner, for example, issued a standing order for naloxone to be available at all of the city’s pharmacies. Brown University and the Rhode Island School of Design collaborated to create NaloxBoxes—emergency naloxone boxes installed at city social service centers that enable any bystander to administer a rescue dose.

Speeding access to addiction treatment.

And, to minimize delays in patients’ receipt of medication-assisted opioid addiction treatments like methadone, New York State has reached agreements with two insurance companies to end their requirements for prior authorization for such treatments. […]

2017-10-23T08:50:26+00:00 October 23rd, 2017|Nursing, Public health|0 Comments

AJN in October: Nursing Student Errors, Septic Shock Resuscitation, the Ethics of Workarounds, More

The October issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Original Research: Exploring How Nursing Schools Handle Student Errors and Near Misses

The authors investigate nursing school policies and practices for reporting and tracking student errors and near misses. The first part of a two-part series.

CE: Assessing Patients During Septic Shock Resuscitation

How to integrate capillary refill time and skin mottling score into the perfusion reassessment after initial fluid resuscitation—as recommended by revisions to the Surviving Sepsis Campaign six-hour bundle.

Obesity and Sexual Dysfunction: Making the Connection

Obesity affects patients’ general health, but does it affect their sexuality? A review of the evidence on obesity and sexual functioning, plus nursing considerations for addressing weight-loss strategies with patients.

Workarounds Are Routinely Used By Nurses—But Are They Ethical?

How nurses can be creative problem solvers without resorting to workarounds that may be ethical in intent yet potentially harmful in their consequences.

[…]

2017-09-29T08:30:14+00:00 September 29th, 2017|Nursing|0 Comments

How Long Should Routine Health Screening Continue in Older Adults?

Photo by Johner Images / Alamy Stock Photo

Communicating to older patients that routine screening tests are no longer recommended can prove difficult. Recent research, however, offers guidance on how nurses and other clinicians should approach such conversations.

As we report in a September news article, a study focused on cancer screening found that older adults unlikely to benefit from certain tests were receptive to recommendations to stop screening, with a caveat: they preferred that life expectancy not be a part of the conversation.

The study’s accompanying editorial notes that broaching the topic of life expectancy can turn a discussion about maintaining health into an unexpected discussion about the end of life, which “may be a shock in the primary care setting at a routine visit.” The authors of the study recommend changing the language used in these conversations—for example, saying “This test would not help you live longer” instead of referring to “life expectancy.” […]

2017-09-06T09:21:09+00:00 September 6th, 2017|Nursing, patient engagement|1 Comment