Practices and perceptions regarding intravenous opioid infusion and cancer pain management

• Published in: Cancer Vol. 125; no. 21; pp. 3882 - 3889
• Main Authors: Arthur, Joseph A., Reddy, Akhila, Smith, Uniqua, Hui, David, Park, Minjeong, Liu, Diane, Vaughan‐Adams, Nicole, Haider, Ali, Williams, Janet, Bruera, Eduardo
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2019
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Cancer; cancer pain; Cancer Pain - drug therapy; Cancer Pain - etiology; Clinical Competence - standards; Cross-Sectional Studies; Emergency medical services; Female; Fentanyl; Fentanyl - administration & dosage; Fentanyl - therapeutic use; Humans; Hydromorphone - administration & dosage; Hydromorphone - therapeutic use; Infusions, Intravenous - methods; Infusions, Intravenous - standards; Intravenous administration; Male; Medical personnel; Middle Aged; Morphine; Morphine - administration & dosage; Morphine - therapeutic use; Narcotics; Neoplasms - complications; Neoplasms - drug therapy; nurse practices; Nurses; Nurses - standards; Nurses - statistics & numerical data; Oncology; opioid infusion; Opioids; Pain; Pain management; Pain Management - methods; Surveys and Questionnaires; Time Factors; Timing devices; cancer pain; nurse practices; opioid infusion
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.32380

Background In view of the recent opioid crisis, ways to promote safe and effective opioid‐related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses. Methods An anonymous cross‐sectional survey was conducted among oncology nurses working in medical, surgical, intensive care unit (ICU), and emergency department (ED) settings. An iv opioid bolus infusion speed less than 120 seconds was considered too fast. Results The participant response rate was 59% (731 of 1234). Approximately 58%, 54%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl, respectively, in less than 120 seconds. The median morphine infusion speeds were 55, 60, 60, and 85 seconds for ICU, surgical, ED, and medical unit nurses, respectively (P = .0002). The odds ratios for infusing too fast were 2.04 and 2.52 for ED (P = .039) and ICU nurses (P = .003), respectively, in comparison with medical unit nurses, and they were 0.27 and 0.18 with frequent (P = .003) and very frequent use of a timing device (P = .0001), respectively, in comparison with no use. Conclusions More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermittent administration of iv opioids to patients with cancer. More than half of inpatient oncology nurses report administering intravenous opioids too fast. Nurses who work in the intensive care unit and the emergency department are over 2 times more likely to administer intravenous opioids too fast in comparison with those working in the medical unit.