AUSTIN, TEX. – A survey of nurses suggests that they might have a knowledge gap regarding the use of opioids at the end of their patients' lives.
Among 181 nurses surveyed at three urban Midwestern medical centers, 65% reported being confident in their ability to titrate a continuous opioid infusion to manage a dying patient's symptoms. Despite that, many nurses incorrectly answered three of four questions designed to test their knowledge of specific opioid practices, researcher Margaret Barnett reported at the annual meeting of the American Academy of Hospice and Palliative Medicine. Most respondents knew the appropriate starting dose for a continuous morphine infusion in a patient admitted with severe pain that was uncontrolled with Percocet (oxycodone with acetaminophen). But they struggled to identify the correct morphine dose for a patient whose pain scores remained unchanged after receiving an intravenous morphine bolus, said Ms. Barnett, an advanced clinical nurse palliative care specialist at University of Kansas Medical Center, Kansas City. Most nurses also failed to identify how many hours it would take a patient to reach a steady state after the continuous infusion of morphine was increased or how long to wait between giving intravenous boluses.
The respondents had an average of 13 years of registered nursing experience, 61% had a bachelor of science in nursing or a higher degree, and 58% had cared for a patient requiring opioid titration in the past year.
The author disclosed no conflicts. The Nursing Honor Society, Sigma Theta Tau International, supported the study.