Instructions: Spend 5-10 minutes reviewing the case below and considering the questions that follow. Case Study 2
Georgia is an intensive care unit nurse with twenty years’ experience in caring for critically injured patients. She is training Moshe, a new nurse fresh from graduate school. One day, as he is returning from lunch, he sees Georgia leaving the room of one of his patients. This pattern repeats over the course of the next month. On one of these occasions, he questions Georgia as to the patient’s condition. Georgia replies that the patient was in pain and needed a bolus dose of fentanyl. The next day, when Moshe sees Georgia leaving his patient’s room, he inspects the fentanyl drip and sees that it has more volume than when he left on break earlier. He further learns that patients on fentanyl drips on this floor have been showing signs of inadequate analgesia. Subsequent investigation shows that the fentanyl drips have been diluted.
1. What is Moshe’s responsibility in this scenario?
2. How might the management of the facility respond?
3. What steps might be taken to safeguard the integrity of patient treatment?
References
7. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug- Related Risks and Outcomes — United States. Surveillance Special Report. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018. 8. National Institutes of Health, National Institute on Drug Abuse. Benzodiazepines and Opioids. https://www.drugabuse.gov/drug-topics/ opioids/benzodiazepines-opioids. Updated February 3, 2021. Accessed June 21, 2021. 9. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. 10. Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs. 2021;81(1):125-156. 11. Faryar KA, Webb AN, Bhandari B, Price TG, Bosse GM. Trending gabapentin exposures in Kentucky after legislation requiring use of the state prescription drug monitoring program for all opioid prescriptions(). Clin Toxicol (Phila). 2019;57(6):398-403. 12. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.
13. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA. 2016;315(15):1624- 1645. 14. Guy GP, Jr., Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697-704. 15. Barriers to Broader Use of Medications to Treat Opioid Use Disorder. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication- Assisted Treatment for Opioid Use 16. Madras, B. K., N. J. Ahmad, J. Wen, J. Sharfstein, and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic. NAM Perspectives. Discussion Paper, Washington, DC. https://doi.org/10.31478/202004b. 17. Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2021, StatPearls Publishing LLC.; 2021. 18. Sacco, Lisa N. Drug Enforcement in the United States: History, Policy, and Trends, report, October 2, 2014; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/ metadc463078/: accessed June 25, 2021), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt. edu/; crediting UNT Libraries Government Documents Department. 19. Drugs of Abuse: A DEA Resource Guide; 2020 Edition. Produced and Published by Drug Enforcement Administration, U.S. Department of Justice.
1. Reynolds K, Kaufman R, Korenoski A, Fennimore L, Shulman J, Lynch M. Trends in gabapentin and baclofen exposures reported to U.S. poison centers. Clin Toxicol (Phila). 2020;58(7):763-772. 2. Everson J, Cheng AK, Patrick SW, Dusetzina SB. Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates. JAMA Netw Open. 2020;3(12):e2027951. 3. Meadows AL, Strickland JC, Qalbani S, Conner KL, Su A, Rush CR. Comparing Changes in Controlled Substance Prescribing Trends by Provider Type. Am J Addict. 2020;29(1):35- 42. 4. Bykov K, He M, Gagne JJ. Trends in Utilization of Prescribed Controlled Substances in US Commercially Insured Adults, 2004-2019. JAMA Intern Med. 2020;180(7):1006-1008. 5. U.S. Department of Health and Human Services. Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations (Final Report). https://www.hhs.gov/ash/ advisory-committees/pain/index.html Published May 9, 2019. Accessed September 1, 2021. 6. Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential - United States, 2003-2017. MMWR Morb Mortal Wkly Rep. 2019;68(17):388-395.
16
Powered by FlippingBook