Theses and Dissertations at Montana State University (MSU)
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Item Pain management of buprenorphine patients in the perioperative setting(Montana State University - Bozeman, College of Nursing, 2024) Hildner, Kate Ella; Chairperson, Graduate Committee: Julie Ruff; This is a manuscript style paper that includes co-authored chapters.Background: Buprenorphine is an FDA-approved medication for the treatment of opioid use disorder and a useful tool in helping patients recover from opioid addiction. Due to the mechanism of action of buprenorphine on opioid receptors, treatment of acute pain in the perioperative setting can be challenging. Local problem: At the facility site, buprenorphine patients who present for surgery have a longer average length of stay in the post-anesthesia care unit (PACU). Nurses also expressed a need for further education and increased proficiency in caring for buprenorphine patients. Methods: The purpose of this project was to increase staff communication, provide specific education to staff about buprenorphine, and decrease the length of stay for buprenorphine patients in the PACU. Interventions: This project involved the implementation of three interventions. The first intervention involved adding chart documentation of buprenorphine status, allowing for notification to the operating room and PACU staff. The second intervention was the initiation of improved communication between the preoperative department and the PACU. The third intervention was an educational presentation and reference sheet that was provided to the PACU staff. Results: After implementation, 80% of buprenorphine patients had a note in their chart alerting the OR and PACU staff of their buprenorphine status, however direct communication between departments only occurred for 20% of patients. 100% of PACU staff nurses reported increased proficiency in caring for buprenorphine patients after education implementation. Conclusion: The QI project resulted in increased staff proficiency and interdepartmental communication, indicating improved care for buprenorphine patients in the perioperative setting.Item Implementation of a multidose naloxone protocol in a rural volunteer emergency medical service: a safety-diven quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Overstreet, Riesa Rachael; Chairperson, Graduate Committee: Stacy Stellflug; This is a manuscript style paper that includes co-authored chapters.Background: Opiate overdose (OOD) deaths are increasing in Montana. Emergency medical technicians (EMTs) are the primary prehospital providers in rural areas and the first contact for many OOD patients. In the last ten years, many states have added naloxone administration to the EMT scope. Now, EMTs administer a third of the naloxone given nationally. Local problem: A rural volunteer EMS experienced patient contact times longer than the duration of naloxone's action. State protocols allowed EMTs to administer one dose of intranasal naloxone. Methods: The Iowa Model--Revised guided the quality improvement (QI) project, which aimed to provide standardized, evidence-based interventions to improve the identification and treatment of patients with OOD, expedite their arrival at definitive care, and ultimately improve patient survival. Interventions: The project team created an evidence-based multidose OOD protocol for the volunteer EMS based on the EMT, scope of practice, and the practice environment. Naloxone and protocol training, badge cards, and substance use identification training supported the protocol implementation. Results: Overall, EMTs reported protocol use for patients with any signs and symptoms of OOD 71% of the time, increasing throughout the implementation period. Fifty percent of patients with evidence-based OOD signs and symptoms received naloxone. Conclusion: The QI project demonstrated that volunteer EMTs could apply the protocol to identify and treat patients with evidence-based signs and symptoms of OOD with similar accuracy to EMS providers nationally. Interdisciplinary partnerships in resource-limited rural settings can support QI efforts and increase the representation of rural populations in the literature.Item Improving standardization in care of patients with chronic pain: a focus on harm reduction(Montana State University - Bozeman, College of Nursing, 2023) Locke, Erin Michelle; Chairperson, Graduate Committee: Amanda H. LucasBackground: The opioid crisis remains a major public health issue in the US, with escalating opioid-related deaths annually. Long-term opioid therapy (LTOT) for chronic pain carries a high risk of adverse events, including opioid use disorder (OUD), overdose, and mortality. Standardizing harm-reduction practices, like risk assessment, naloxone access, and early OUD identification, can mitigate risks and enhance patient outcomes. Local Problem: Primary care patients with chronic pain on LTOT need harm reduction to improve patient safety and quality of life. Methods: A six-week plan-do-study-act cycle was employed. Descriptive statistics assessed intervention feasibility. Intervention: The Opioid Risk Tool (ORT) evaluated individual risk for developing an OUD. Patients who screened positively (score > or = 3) on the ORT received provider evaluation, using DSM-5 criteria, for OUD diagnosis. If diagnosed, patients received education about OUD and treatment options with buprenorphine. Naloxone prescriptions were offered by nurses to all patients with chronic pain. Results: All 17 patients with chronic pain completed the ORT, with 9 (53%) identified as high-risk, and 2 (11.8%) diagnosed with OUD. No referrals were made for buprenorphine therapy. Additionally, 13 (76%) patients were offered naloxone prescriptions, and 100% of offered prescriptions were filled. Conclusion: Implementing harm-reduction practices for patients on LTOT for chronic pain is feasible. Further projects will assess the long-term sustainability and impact on patient outcomes.Item Promoting opioid stewardship in an orthopedic ambulatory surgery center: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Stromberg, Sara Elyse; Chairperson, Graduate Committee: Margaret HammerslaOverprescribing opioids poses a substantial risk to patients and communities as it may result in patients continuing to use or in-excess pills that can become diverted to others. Postoperative prescribing guidelines address the national epidemic at the local level by reducing the availability of opioids for nonmedical use. This project sought to align the postoperative discharge opioid prescribing practices of a small orthopedic ambulatory surgery center (ASC) in southwestern Montana with best practices. The evidence-based postoperative prescribing guidelines were pilot tested with a targeted surgical procedure over four weeks. Patients meeting inclusion criteria were prescribed an opioid pill quantity within the recommended amount was inconsistent, with the most adherence reaching 25%. Mechanisms within the electronic health record (EHR) system are recommended to improve adherence.Item Opioid guideline adherence for Tramadol in those with chronic nonmalignant pain(Montana State University - Bozeman, College of Nursing, 2020) Horine, Harold James, III; Chairperson, Graduate Committee: Susan LuparellPain is a very common problem affecting up to one-third of the entire population of the United States at any given time and for those with pain, 1 in 3 people have chronic nonmalignant pain lasting longer than 3 months (Centers for Disease Control and Prevention [CDC], 2016b). A majority of those with pain are seen in a primary care setting initially, and sometimes on an on-going basis (Gatchel, 2004; National Institute of Health [NIH], 2010). Ensuring comfort by addressing pain levels in patients is a primary, ethical nursing duty. Historically, one common modality used to treat pain is the use of opioids. However, the literature indicates that healthcare practitioners at all levels receive little education on how to manage chronic pain utilizing prescription opioids in the primary care setting. A lack of education on prescribing opioids has helped create an epidemic of dependence and overdoses on opioids. Additionally, the opioid crisis has continued despite many attempts at various levels, including executive and legislative bills, to try and stop opioid abuse and overdose. Although originally touted as a safe alternative to opioids and slightly stronger than over-the-counter analgesics, tramadol is an opioid with regulation by the Drug Enforcement Agency and Food and Drug Administration that, upon review, does not appear to be in line with the gold standards for prescribing opioids, such as the 2016 Center for Disease Control and Prevention guidelines or the 2018 Montana Utilization and Treatment Guidelines, for nonmalignant chronic pain management with opioids. The purpose of this project was to assess provider knowledge related to tramadol and providers' adherence to the present opioid guidelines when prescribing tramadol in a small, southwestern Montana community.Item Implementation of an evidence-based policy and educational program on caring for neonates withdrawing from opioids: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Olson, Amy JoAnn; Chairperson, Graduate Committee: Stacy StellflugThe opioid use among pregnant women has increased, which has led to a rise in the rate of Neonatal Abstinence Syndrome (NAS). Infants with NAS are delivered at rural and urban locations throughout the country and require specialized treatment. The rural community access hospitals (CAH) often lack the resources (policy development and education updates) to prepare health care team members for safe care of infants that present with NAS. The purpose of this project was to improve team member confidence when providing care for neonates suspected of substance withdrawal at a CAH in Montana by: (a) developing and implementing a policy on care and treatment of a drug dependent newborn; (b) educating the team providing care to these neonates on the use of NAS scoring tools; and (c) evaluating the education and improved confidence levels of the health care team. A pretest/posttest design was used to evaluate change in nursing knowledge on NAS/scoring tools. The results suggest implementation of a NAS educational program including education regarding the implementation of a corresponding evidence-based policy, has a statistically significant effect on provider and nurse knowledge and confidence about NAS. Specifically, the results suggest NAS education improved provider/nurse knowledge and confidence in caring for neonates affected by NAS.