Prolonged use of paracetamol and the prescribing patterns on rehabilitation facilities.

AIMS AND OBJECTIVES: The study investigated: (a) the usage patterns of paracetamol, and (b) the association between paracetamol use and patient outcomes such as liver and kidney functions among older people. BACKGROUND: Paracetamol is a well-known analgesic and antipyretic drug, with an excellent safety profile when used within its recommended dose. It is a commonly used drug by people aged over 65 years to treat chronic pain. Prolonged use of paracetamol in the elderly is poorly understood. As such, there is a genuine risk among older people of unintentional overdose. METHODS: A retrospective analysis of medical records in rehabilitation wards was undertaken from 1 July 2016 to 30 June 2017. Patients' paracetamol use, prescribing patterns and biochemical results were analysed to assess for differences in admission and discharge biochemistry results. The TREND Statement was utilised to guide study reporting (Enhancing the QUAlity and Transparency Of health Research, 2021). RESULTS: A total of 1119 patients were admitted for seven or more days in a metropolitan tertiary hospital in Melbourne. Almost three-quarters (74%) of patients were administered paracetamol; 76.1% received 'Immediate-Release Paracetamol' (IRP), and 23.9% were given 'Sustained-Release Paracetamol' (SRP). A proportion (4.5%) of patients in both the IRP and SRP groups received more than the daily recommended dose. There were limited statistically significant differences between patients' admission and discharge biochemistry results; group or time differences were observed, which were indicative of improvements within the paracetamol group. CONCLUSION: Paracetamol was a commonly used medication among long-stay elderly patients. Precaution to ensure paracetamol use does not exceed recommended daily doses is required. This study suggests that paracetamol used at a therapeutic level in older patients had limited, negative associations with liver and kidney function. RELEVANCE TO CLINICAL PRACTICE: The clinical practice regarding prolonged use of paracetamol is ambitious. The increased risk of paracetamol toxicity among the frail elderly is a concern. Optimising the dose adjustment in the elderly is important to avoid adverse outcomes.

The Pain Nurse Practitioner and Pain Nurse's Role and Views on Opioid Management in Australia: A National Questionnaire Survey.

BACKGROUND: The demand for access to Australian pain management services is growing. The dual crisis of opioid misuse and chronic pain, means pain nurses and nurse practitioners (NPs) have a unique opportunity to meet clinical demands and advance their scope of practice. AIMS: To understand the role of pain nurses and pain NPs across Australia and explore their perceptions of current opioid management. DESIGN: This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. METHODS: This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. Survey respondents were contacted via the eight nursing Pain Interest Groups in Australia. RESULTS: Acute pain management (92.7%) and chronic pain management (80.5%) were the primary services provided, with pain specialty nurses providing nurse education (100.0%), patient support, clinician education, and policy development. Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation. CONCLUSIONS: Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.

Opioid induced constipation management in orthopaedic and trauma patients: treatment and the potential of nurse-initiated management.

BACKGROUND: Opioid analgesics treat moderate to severe pain with proven analgesic efficacy, although their use is associated with dose-limiting side effects, such as constipation. Orthopaedic and trauma patients are at high risk of developing opioid-induced constipation (OIC) due to reduced mobility and increased opioid requirements to manage prolonged pain after injury. OBJECTIVES: To examine the evidence base to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC and nurse-initiated management of OIC. METHOD: A review of the literature was undertaken. Databases were searched to identify studies on OIC, laxatives and nurse-initiated management. RESULTS: Laxatives do not address the underlying cause of OIC and there is currently insufficient evidence to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC. The use of peripheral acting mu-opioid receptor antagonists (PAMORAs) could be considered in those for whom regular use of a combination of laxatives has not been sucessful, and nurses should take a broader role in the assessment of symptoms and response to treatment. CONCLUSION: The important balance between adequate analgesia and minimising OIC symptoms is an ongoing challenge for clinicians, and an area of patient care where nurses could be leading management.

Nurse-led extubation in the post-anaesthesia care unit.

Weaning of mechanical ventilation occurs in intensive care units by nurses, which stimulates the prospect of nurse-led extubation extending into the PACU environment for improved patient outcomes and reduced demand of hospital resources. Nurse-led patient extubation in the PACU, would involve specially trained nurses weaning mechanical ventilation via an established protocol for a specific patient group, prior to the patient being extubated by an anaesthetist or intensivist.

Disaster education and preparedness in the acute care setting: A cross sectional survey of operating theatre nurse's disaster knowledge and education.

BACKGROUND: Operating theatre services can be heavily relied upon during mass casualty disaster events, which require nurses to have adequate training and education of hospital disaster management plans to respond appropriately. The evidence-base of disaster preparedness in the acute setting is limited, particularly with regard to operating theatre nurses. OBJECTIVES: Explore operating theatre nurse's disaster knowledge of their role in a mass casualty event, and identify the preferred mode of disaster education and training to improve disaster preparedness. DESIGN: A cross-sectional research design was employed with data collected using a survey tool. SETTINGS: The research was undertaken on operating theatre nurses in a tertiary hospital in Victoria, Australia. PARTICIPANTS: The participants in this research included 53 operating theatre nurses, 51 Registered Nurses and 2 Enrolled Nurses. METHODS: The survey was based on a disaster questionnaire for emergency department nurses from South Australia, exploring knowledge and preparedness for disaster response in the acute setting, and altered to be specific and relevant to the operating theatre environment and broadened to focus on the training needs of perioperative nurses. RESULTS: The survey of 53 operating theatre nurses identified that few had previous disaster experience (19.9%). The majority of respondents were aware of their disaster management policy (Code Brown policy) (94.1%), of reporting lines, and appropriate triage (80.4%). However, a significant number of nurses (50.9%) stated that in the event of a disaster they would "call work to see if [they needed] additional assistance" compared with 43.4% of respondents "wait to be contacted by a manager/floor coordinator" as was policy. Finally, disaster nursing general knowledge amongst staff was poor; a mean of 1.79 (SD = 1.20) correct answers out of a possible 7. CONCLUSIONS: This study highlights that disaster education and training methods for disasters be specific to the role required by nurses and all staff during a disaster activation; training drills are preferred although face-to-face education is practical.