K. Hitchcock fishbone_template
KHitchcock Journal Club Critique Form
I chose to do my research over reducing opioids in children population. I feel that this is important because of the opioid crisis the world is experiencing right now. We, as healthcare providers, need to limit the use of opioids with pediatric patients and help reduce the possibility of addiction later in life. Nurses should educate and encourage the use of non-pharmacological pain management in place of opioids.
I agree with your topic 100%. I feel that use of non-pharmacological pain management should be used as much as possible in all populations but especially in children. I work as a pediatric nurse with patients that suffer from painful conditions and many of them are on pain medications. There are so many side effects such as, “constipation, nausea and vomiting, itching or rash” that only add to the discomfort a patient is already feeling due to the pain. Patients are also more likely to remain in pain longer due to relying on the medication to help them counteract what they are feeling. All in all this can lead to a very serious risk of dependency just as you stated. I loved in your fishbone diagram the part about guided imagery because I do use that with my patients as much as I can!
Safe Use of Opioids in Children – University of Michigan. (n.d.). Retrieved February 25, 2020, from http://www.med.umich.edu/1libr/PainSteeringCommittee/OpioidsChildren.pdf
It is sad that the medications we give to our patients to try and help them can end up leading them to have more issues. I do understand that medications are sometimes necessary, but if we can eliminate the dependency on going straight to medication I feel like we set the children up for more success in the future. For example, when I start to get a headache/migraine, my first thought is not medication because most of the time it does not work for me. My first go to is usually massaging my head in a place that is sore. It is uncomfortable for a short time, but if I can endure that pain for a little bit, usually my headaches will go away for a little bit at least. Although it does not always work and sometimes does not help at all, it is something I try and teach my patients that I know suffer with headaches and migraines.
This is a great topic. The opioid crisis has become a big issue in the past few years. Being able to identify whether opioids are needed versus using other forms of pain management is important because using opioids has many other effects than just pain management. The article I found states that there are currently no general guidelines for opioid usage in the pediatric population and that the CDC says there is limited evidence in the use opioids for chronic pain in children and adolescents. According to this article, a recent study showed that use of opioid use among adolescents before high school graduation is correlated with a 33% increase in the risk of future non-medial opioid use when reaching young adult hood (Matson et al, 2019).
There are so many other options for non-opioid pain management that is very beneficial. Providers, pharmacists, and nurses all should be able and willing to educate patients and parents of patients of these options before resorting to opioids for pain management. The article listed NSAIDS, neuropathic pain options (Lyrica, Cymbalta, or lidocaine patches), as well as non-pharmacological modalities such as biofeedback, acupuncture, and distraction techniques (Matson et al, 2019). Being able to use these options first before resorting to opioids would decrease the risk of narcotic abuse that has led to our opioid crisis today.
Source:
Matson, K. L., Johnson, P. N., Tran, V., Horton, E. R., Sterner-Allison, J., & Advocacy Committee on behalf of Pediatric Pharmacy Advocacy Group (2019). Opioid Use in Children. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 24(1), 72–75. https://doi.org/10.5863/1551-6776-24.1.72
That is a great article you found! Thank you for sharing! Those statistics are fascinating to me because like you said, there are so many non-opioid and even non-pharmacological pain management techniques. Unfortunately, many healthcare professionals are willing to teach about the dangers and alternatives, but there simply is not enough time. I see it in my practice every day. We are pushing our providers to get through a certain number of patients in a day because the other providers do. Well, not all the providers address all the issues and not all providers provide teaching and education to the patients like some do.
This is a great topic. Over the past few years the opioid overdose epidemic has rightfully gotten attention. In the past, the addictiveness of most of the opioid medication was understated. I agree that it’s very important to implement nonpharmacological interventions such as distraction and guided imagery and use opioids as a last resort. One of the studies showed unfortunate fatal incidents in children who were prescribed opioids without severe conditions. “In this cohort of children enrolled in Medicaid without severe conditions, 15% of children filled outpatient opioid analgesic prescriptions annually for acute, self-limited conditions. One of every 2611 study opioid prescriptions was followed by an opioid-related ED visit, hospitalization, or death; more than two-thirds of these were related to therapeutic use of the prescribed opioid” (Chung et al. 2018).
Chung, Cecilia P., Callahan, S. Todd, Cooper, William O., Dupont, William D., Murray, Katherine T., Franklin, Andrew D., . . . Ray, Wayne A. (2018). Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events. Pediatrics, 142(2), Pediatrics, August, 2018, Vol.142(2).
Opioids are so scary! Guided imagery is such a good fit for pediatrics because they have such a creative imagination at a young age. If we can get them to tell us a story or get them to watch a TV show or movie then hopefully we can help get them through trying times. We are hopefully setting them up for success in the future also. I cannot believe the statistics you shared with me. It makes me so sad that things that are given to patients and parents as something “helpful” turn out to be harmful than helpful.
I have never even thought about the opioid usage with children. I am in full agreement that we should try to teach other pain management techniques with children before starting them on medications. I am also wondering how many of the children that have been prescribed opioids are become dependent on them later in life. I found an article that gives some statistics on opioids in children. The article basically covered what they are being prescribed for (mostly for dental work) and how many deaths have been attributed to opioids (3 deaths out of 1.4 million children). The article also goes on to explain how we just don’t have the numbers or research yet (Journal of the American Academy of Pediatrics, 2018). I think that the opioid issue is common knowledge among adults and now new regulations are being put in place to help “fix” the problem. I love that you chose to research how to prevent it for future generations altogether.
Reference:
Krane, E., Weisman, S., & Walco, G. (2018, August 01). The national opioid epidemic and the risk of outpatient opioids in children. Retrieved February 28, 2020, from https://pediatrics.aappublications.org/content/142/2/e20181623?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=Pediatrics_TrendMD_0
I feel that it is natural for us as humans to look for a “quick fix” and for some prescribing opioids is that. No one likes to see pediatrics in pain, we want to hurry and make things better as healthcare providers, we want to help and help fast. Sometimes we need to stop and think that quick is not always best. Unfortunately, most nurses will find it easier to spend 5 minutes passing medication than 20 minutes fighting with a child trying to distract them from pain.
I really like your topic as it is a major concern. Misuse of opioids in children lead to problems with abuse of drugs as adults. Education is key on the opioid crisis. The Pediatric Pharmacy Advocacy Group recommends “pharmacists participate in pain management discussions, including non-opioid alternatives and provide naloxone recommendations for specific populations. Further roles include reviewing prescription drug-monitoring programs prior to dispensing to help curb trends of misuse. PPAG supports education by pharmacists of proper administration, storage, and disposal in households with children and adolescents, as well as their families’ understanding of the dangers of opioid misuse and use disorder. PPAG also advocates for the improvement of access to evidence-based pharmacotherapy for adolescents with opioid use disorder and for pharmacists to assist facilitation of patient referrals.” It’s great to see more and more education out there to get people informed to help with this very serious crisis.
Reference:
Sterner-Allison, J.PharmD, Horton, E. PharmD, Johnson, P. PharmD, Matson, K. PharmD, Tran, V. PharmD. (2019). Opioid Use in Children. The Journal of Pediatric Pharmacology and Therapeutics: JPPT. 24(1): 72-75. doi: 10.5863/1551-6776-24.1.72.
What I personally feel is one of the saddest parts of this is that we don’t always know what the children will endure in the future. Education on proper use is key. We also need to make sure we are providing education on things to try such as distraction, guided imagery, singing, and other non-pharmacological pain management techniques. I think proper disposal is also something that needs to be taught more.
What an interesting study. I found something that might interest you. A study by Hesham et al. (2019) found that nurses within the hospital setting are the professionals holding the most responsibility for patient pain management, and that non pharmacological pain management techniques have been shown to be effective in producing better health outcomes. Yet the nurses in their study (pediatric oncology nurses) had little knowledge of non-pharmacological pain management techniques. Hersham et al. (2019) found that formally training nurses on non-pharmacological pain management practice and knowledge through their educational training program increased nurse’s knowledge and use of these techniques 100%. Hersham et al. (2019) recommended that formal training programs like these be used for pediatric oncology nurses because this is an effective way to reduce patient pain levels in a non-pharmacological way.
Reference
Hersham, M., Dakhakhny, A., Ramadan, R., Besheer, M. (2019). PB2279 Effect of educational training program on improving pediatric oncology nurses, practice regarding non pharmacological pain management. HemaSphere, 3 (S1), 1018. doi: 10.1097/01.HS9.0000567584.58810.12
I love this study! Thank you for sharing! I think this shows the importance of training not only pediatric nurses, but all nurses on non-pharmacological pain management techniques. I think it is something that every single nurse can benefit from whether it is personally by using it with a family member or professionally by helping a patient. We spend so much time in meetings that may or may not be beneficial to us, why can’t we have this as a meeting once a year.
There is no doubt that we are experiencing an opioid crisis in this country. Last semester, I did a group project with some classmates on pain management. The most interesting part for me was the use of alternative pain therapies.
I had the privileged of watching an amazing nurse help my aunt with uncontrollable pain a year ago. She was newly diagnosed with renal cell carcinoma that had metastasized into her lungs and spine. She was quite sensitive to opioids and would become unresponsive with their use, so it was a fine line between horrendous pain and respiratory depression.
She was having a particularly bad day when the most amazing nurse took over her care. She was able to make a connection with my aunt and helped her to get past the pain by singing hymns with her. I was in awe of this nurse and her extraordinary attention to making my aunt comfortable.
Today this nurse and I are friends and she is so passionate about the way we treat pain in our patient. She’s making a difference by helping to educate other nurses about alternative approaches to pain management.
It turns out that these approaches are not just for adults. Children are incredibly susceptible to distraction and are so in tune to play that using their imaginations comes so much easier for them than it does for adults. Because of that, guided imagery is a fantastic technique for children to help reduce their pain and anxiety (Gerik, 2005). Childlife Specialists are such a amazing resource, too. They make the hospital so much less scary for kids.
Resource:
Gerik, Susan M. (2005). Pain management in children: Developmental considerations and mind-body therapies.(Featured CME Topic: Complementary and Alternative Medicine). Southern Medical Journal, 98(3), 295-302.
Wow! That is so amazing! I am so glad that they were able to find something that could help your aunt! It still amazes me each time I hear stories like your aunts. I research this stuff because it is something I am passionate about, and every time I am in awe of what something so simple that we all overlook can help someone who is losing hope. At our clinic, we have a provider who is passionate about getting patients off opioids and I love sharing stories like this with them. Lots of them come back and share that distraction is the easiest one for them to implement. They share that when they can get their mind to be focused on something else, they can push past the worst.
There is a huge problem with opioids in both adults and children. The push is to use alternative methods to reduce pain. Opioids have to be more closely monitored.
Safe use of opioids is vital in children and adolescents. As medication experts, pharmacists are positioned to make a considerable impact on opioid use and safety. Pediatric Pharmacy Advocacy Group (PPAG) recommends pharmacists participate in pain management discussions, including non-opioid alternatives, and provide naloxone recommendations for specific populations.
Matson, K. L., Johnson, P. N., Tran, V., Horton, E. R., Sterner-Allison, J., & Advocacy Committee on behalf of Pediatric Pharmacy Advocacy Group (2019). Opioid Use in Children. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 24(1), 72–75. https://doi.org/10.5863/1551-6776-24.1.72
I think looking into non-opioid pain management alternatives will benefit our patients in the long run. Opioids are starting to be more closely monitored and that is a plus. I think that if we teach our children at a young age to not look for an easy solution to pain such as an opioid, we will help set them up for success in the future. If we teach them that not everything can be solved quickly and that sometimes we have to trick our minds, we can help them use the techniques in future situations.