Road Map for Opioid Management in the Inpatient Setting: A Structured Approach to Opioid Selection and Titration

INTRODUCTION: Effective pain management is a major challenge of medicine as patients with acute and chronic pain conditions require careful evaluation and treatment. Despite required pain management education in postgraduate training, effective pain management is often not achieved in the hospital setting. For example, the Accreditation Council for Graduate Medical Education in 2007 required internal medicine residencies to include instruction on pain management. However, studies have demonstrated a lack of pain management knowledge in trainees in pediatrics, neurology, internal medicine, and family practice. This includes a lack of basic skills in pain assessment, knowledge of narcotic pain medication pharmacology, and management of patients with pain at the end of life. METHODS: We developed the Road Map for Opioid Management in the Inpatient Setting as an instructional method via a PowerPoint-based slide show to guide clinicians on the thought process for opioid selection and titration. We include opioid conversion cards, additional resources, questions for self-efficacy and knowledge pre- or postassessment, and a posttest. Our educational intervention was successful. RESULTS: After initial training, over 60% of learners (i.e., residents, fellows, and other health care professionals) felt confident or extremely confident in each of the following: choosing an opioid for patients with renal failure, determining when to dilute naloxone for opioid reversal, converting fentanyl patch to fentanyl drip, and determining which pain scale to use for nonverbal patients with dementia. DISCUSSION: Our instructional program is an organized and effective tool to provide education for opioid management to clinicians.