Date of Award

5-14-2021

Degree Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Dr. Sarah M. Killian

Second Advisor

Dr. Megan Freeman

Abstract

Abstract

Background: The prevalence of opioid abuse in the United States is high and associated with a surge in mental illness, emergency department visits, hospitalizations, readmissions after discharge, and unintended overdose deaths. Previous research identifies orthopedics as a significant contributor to the crisis, most notably total knee replacements. Inconsistencies with provider education throughout the US may be contributing to the opioid epidemic.

Objective: To explore the correlation between provider knowledge and decreased patient-reported use of opioids and to determine knowledge gaps for development of provider education.

Clinical Question: Does increased provider knowledge decrease patient-reported use of opioids?

Method: A retrospective, cross-sectional descriptive design was used for this quality improvement project. Lewin’s Theory of Change was used to guide the implementation. Use of the KnowPain-12 survey to assess provider knowledge. Patient-reported opioid use completed via FORCE-Therapeutics.

Results: Ten providers participated in the project. One hundred percent identified as male, 80% were above the age of 45 years of age, 50% practiced as an orthopedic surgeon for more than 20 years, and 80% stated they received, participated, or taught pain medication education in the previous five years. A total of 1482 patient records were reviewed. Records were separated into two groups: total hip and total knee surgical replacements, there was no significant difference between laterality of procedure, age, or sex between the patient groups. Higher provider knowledge was moderately positively correlated (0.56) with overall opioid consumption postoperative week zero through six in total knee arthroplasty patients and weakly positively correlated (0.24) in total hip arthroplasty. However, at various time points throughout postoperative day zero through six, opioid consumption was negatively correlated with provider knowledge. Additional findings indicate higher provider knowledge was negatively correlated with NSAIDs, anti-inflammatories, and VAS pain.

Conclusion: Overall, the results did not confirm a clear consistent correlation between patient-reported opioid use and provider-specific knowledge. Further research is recommended with a larger sample size or providers and patients.

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