Nursing Advocacy and the Accuracy of Intravenous to Oral Opioid Conversion at Discharge in the Cancer Patient

Pain is a common problem for cancer patients at home and when hospitalized. Pain interferes with all aspects of a patient\u27s life including sleep, appetite, sexual desire, emotion and productivity. The under-prescribing of opioids can lead to uncontrolled pain in cancer patients. This study examined nursing advocacy related to pain management and the accuracy of the intravenous (IV) to oral (PO) opioid conversion at discharge in cancer patients. Retrospective chart audits were done on 50 cancer patients. The physicians in the charts surveyed who prescribed the discharge medications consisted of a mix of hematologist/oncologists, surgeons and internists/hospitalists in a southwest Florida community. Fifty nurses were also surveyed and asked how comfortable they are in advocating for their patient\u27s pain control and how often they actually advocate for proper pain management. This was done in the same southwest Florida hospital. The most common cancer diagnoses of the patient subjects were colorectal cancer and esophageal/lung cancer. The results of this study show that an overwhelming majority of cancer patients (47 of 50), received doses that were not accurately converted from intravenous to oral opioids at the time of discharge from the hospital. This conversion was based on the Johns Hopkins Opioid Conversion Tool. Nurses in general reported that they are comfortable in advocating for their patients\u27 pain control, but more so in more autonomous areas of practice such as intensive care. The results were overwhelming in the direction of poor control of patient pain. This study leads to the need for further research in the important area of pain control for cancer patients. It also indicates the need for additional education for physicians and nurses about pain control and opioid conversion