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Study: Discharge measures needed following narcotic administration

Wednesday August 27, 2014
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EDs lack uniform measures for discharging patients who receive Schedule II or III narcotic medications, according to a study published online Aug. 19 in the Journal of Emergency Nursing.

The qualitative study focused on 19 emergency nurses from throughout the U.S. who were recruited from a larger group of 848 emergency nurses who preregistered for a March 2014 national conference.

“Participants reported drug-to-discharge times of 0 minutes to 240 minutes after administration of Schedule II and Schedule III narcotics specifically and ‘any medication’ generally,” the researchers wrote. “The most common reason for a wait of any kind was to assess patients for a reaction.”

The purpose of wait times was mainly to check patients’ responses to the medications in terms of pain, the study stated. When it came to criteria for discharge readiness, participants said they checked patients’ physiologic, cognitive and social conditions, according to the study. Among the important physical assessments were vital signs, mental status, ambulation and pain levels.

Still, concern was expressed about the way medications could affect every individual differently. Participants agreed all patients who receive Schedule II or III narcotics would need rides home following discharge. Nurses also agreed certain patients, such as the elderly, those who live alone or those who operate farm equipment or other machinery, would require some type of monitoring after discharge.

Study respondents also noted the decision about whether patients were ready for discharge is mostly left to the primary nurse, with discharge practices varying and being administrative-personnel dependent instead of administrative-systems dependent. The study also showed that discharge practices are based more on tradition rather than evidence.

RNs in the study suggested facilities develop policies and checklists to help with discharge readiness decisions. These would include objective measures such as vital signs, level of consciousness, ability to ambulate and pain scale.

“Other considerations in the discharge decision, such as safety in the community, may not be as easily incorporated into a discharge tool but might prompt the use of other resources,” the researchers wrote.

For more information, visit http://www.ena.org/about/media/PressReleases/Pages/ENAReportEvidenceBasedDischarge.aspx.


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