Pain Management | Medicines Training For Nurses, Nurse Training Course Australia

TGA warns about paracetamol use ….even at therapeutic doses!

The TGA has warned in its Medicines Safety Update last week (4th August 2012) to be cautious with the use of paracetamol even at therapeutic doses. Read it here “Accidental Paracetamol Poisoning”

The TGA reports that in a study of 662 patients, it was found that 48% of patients suffered accidental paracetamol poisoning, resulting in paracetamol induced hepatotoxcity.

Patients with increased risk factors may be susceptible to paracetamol toxicity when given the recommended therapeutic dose of 1gram QID.

MedRN discussed this similar issue in our blog on the 15th December 2011 (entitled Maxed out on Paracetamol – Read it here).

Patients at increased risk includes:

High alcohol intake,
Drug interactions – rifampicin or some antiepileptics, other paracetamol-containing products.
Fasting or vomiting resulting in dehydration,
Malnourished,
Underlying liver dysfunction.

This discussion is not suggesting withholding paracetamol unnecessarily unless there are the risks mentioned above. A balanced approach to the Quality Use of Medicines holds true with paracetamol and where required, paracetamol can still be beneficial as a base-line analgesic with benefits seen in osteoarthritis, a chronic pain condition.

MedRN’s Chronic Pain DVD Series, endorsed by the Australian Pain Management Association and Pain Australia, covers this topic in comprehensive detail. It is vital that the competency standards of the Nursing and Midwifery Board of Australia is met with updated medication knowledge in the management of acute and chronic pain.

Digesic and Doloxene to Stay! TGA overuled by AAT

On June 21, 2012 / dextropropoxyphene, Evidence based medication, Nurse Education, Pain Management, Pain Medication / Leave a comment

In February 2012 we reported that the TGA’s (Therapeutic Goods Administration) decision to remove DiGesic and Doloxene from the Australian market was appealed by Aspen Australia, with the Administrative Appeals Tribunal (AAT) allowing their sale until a final decision was reached.

As reported by Pharmacy News this week, the push for the removal of these medicines, has been overruled by the AAT in favour of DiGesic and Doloxene remaining on the market.

“The decision to allow DiGesic and Doloxene in the Australian market recognised that there was a small group of the population who benefited from dextropropoxyphene and removing this medicine would mean that these people may not find other analgesics as effective or tolerable.” – Pharmacy News.

It is likely that there will be stringent conditions placed on the use and monitoring of those taking DiGesic and Doloxene. Stay tuned for these.

If your patients are taking either DiGesic or Doloxene, it is likely that they can continue with these analgesics, however will require close monitoring and an awareness of their adverse effects.

Monitoring considerations:

Evidence has shown that dextropropoxyphene increases the risk of serious arrhythmias (i.e. the normal rhythm of the heart is disturbed) particularly at higher doses or overdoses. Regular use may lead to accumulation of the parent compound causing dizziness and confusion, with the elderly at high risk for these adverse effects.

Other Options:

Are there other analgesic options for the management of chronic pain? Update your knowledge on chronic pain treatments with MedRN’s Chronic Pain 4 disc DVD series. You can watch the previews here.

Can a secondary dressing be used to secure an opioid transdermal patch?

On March 1, 2012 / Evidence based medication, Medication Education, Nurse Education, Pain Management, Pain Medication / Leave a comment

Question: If an opioid transdermal patch (Norspan or Durogesic) does not adhere can I secure it with a secondary dressing?

For some patients who live in warmer climates especially over summer months, the patch does not adhere to the skin due to sweating. The patch begins to peel off before it is ready to be changed.

Answer :

The main problem when applying patches is the temperature of the skin. Heat increases absorption of the drug which can lead to increased release of the drug from the patch. In some instances that has been fatal, or resulted in drug overdose. The product information advises against wearing the patch in saunas or near a heat source, eg. near a heater. The patch should be monitored closely if the patient is suffering from a fever. In contrast, in cold temperatures, the release rate can be slower, resulting in less analgesia.

The application instructions from the product information advises the following: The patch should be pressed firmly in place with the palm of the hand for approximately 30 seconds, making sure the contact is complete, especially around the edges.

Thus, in order to achieve firm application and complete contact, a patch that is not adhering will need assistance. A thin, breathable dressing, such as Tegaderm, Opsite, Hyperfix or similar can be used. As the external and third lining of the transdermal patch is made of an inert material, with the medicine in a matrix in the middle layer of the patch system, there is no reason why an external secondary dressing cannot be used. The breathable secondary dressing can be applied over the whole opioid patch. Some nurses have been securing just the edges of the patch, however this is not necessary. Whilst there are no clinical trials specific to the use of secondary dressings over opioid transdermal patches, the makers of Durogesic, Jansen Cilag, supports this in those patients who require it.

If a patient requires a secondary dressing over their opioid patch, documentation is vital so that there is consistency of practice. Variation in practice - where on one patch change a secondary dressing is used and at the next patch change it is not used - is not optimum clinical practice.

A similar question was asked on Medscape:

Question: If a fentanyl patch comes off or becomes loosened before a scheduled patch change, can it be replaced with a new one?

Answer: In my experience, it is important to apply a new patch to the same location on the skin as the prior patch. This is because the skin depot of fentanyl accumulates during patch adherence is already available and it will be less likely to result in a decrease in serum concentration from a break in therapy. The newly applied patch should remain on for the full 72 hours or as otherwise directed by the prescription.

The two opioid transdermal patches currently on the market are Norspan and Durogesic patch. Are you up to date with how Norspan and Durogesic work and the difference between the two? MedRN’s Chronic Pain DVD Series, discusses these medicines in detail and in an easy to understand way so that you can administer these medicines with confidence.

Watch the PREVIEW CLIPS here.

UPDATE ON THE LATEST – AAT ruling: Di-Gesic and Doloxene to remain…..For now!

On February 23, 2012 / dextropropoxyphene, Evidence based medication, Medication Education, Nurse Education, Pain Management, Pain Medication / 2 Comments

It appears that as the last blog went to press, it has been advised that, the manufacturers of Di-Gesic and Doloxene (both brands containing dextropropoxyphene)

have appealed to the Administrative Appeals Tribunal (AAT). It has been decided that Di-Gesic and Doloxene should remain available for the time being — at least until the final AAT hearing has taken place, or until further order of the AAT.

This does not apply to Capadex and Paradex and as announced they will be discontinued after 1st March 2012.

For the time being, whilst Di-Gesic and Doloxene may be still on the market the question is for HOW LONG? The advice has not changed for any of these medicines containing dextropropoxyphene and the potential harms outweigh the possible benefits. So continue to monitor carefully. Perhaps what it may allow for you is a little more time to reassess your patient’s pain needs and alternatives should still be seeked as soon as possible.

Peak bodies like the National Prescribing Service support the TGA’s decision to discontinue all products containing dextropropoxyphene.

MedRN will keep you posted on further outcomes to this appeal.

Joyce McSwan MedRN Medication Education for Nurses

Integrating people, policies, science and education…..The Australian Pain Society – 32nd Annual meeting is COMING!

On February 17, 2012 / Medication Education, Nurse Education, Pain conference, Pain Management, Pain Medication / Leave a comment

The Australian Pain Society is having its 32nd Annual Scientific Meeting

1-4th April 2012 at Melbourne Convention and Exhibition Centre, Victoria

This conference is a great opportunity to meet others in the field of pain management and a wonderful opportunity to integrate perspectives of pain.

It will bring together a wonderful array of experts from all fields….yes, including consumers.

Visit the Australian Pain Management Association’s exhibition where MedRN will also have our brochures on display.

If you are in the area, it would be worth dropping in.

Meeting A Need…..

On February 10, 2012 / Mackay Pain Support Group, Medication Education, Nurse Education, Pain Management, Pain Medication, Transforming evidence into practice / Leave a comment

Joyce McSwan of MedRN has made news in Mackay this week. The needs of Chronic Pain sufferers in Mackay will be met in March when Joyce McSwan in partnership with the Australian Pain Management Association brings a pain support group to its residents.

Founder of MedRN, Joyce, is a strong advocate that education is not static. Effective education needs to be a two way street. There has to be INPUT and OUTPUT, that is , evidence learnt needs to be transformed into practice if we are to be effective at what we do.

In chronic pain management there is always a fine balance between under medicating and over medicating. New evidence both in Australia and internationally have required clinicians to re-learn what they were once taught about pain and its management. We are now seeing that pain medicine is not the be all and end all. To rely on pain medicine as the sole answer for chronic pain is not optimising therapy. But is there more that we can do?

To treat persistent pain effectively, we must first understand it. Regardless of the cause, sufferers with chronic pain become encapsulated with psychological and environmental changes which they are often unable to overcome. It is when these areas are addressed that pain medicine is enhanced in its effectiveness.

It was this very insight that the use of a multi-modal treatment strategy was needed for injured soldiers after World War II that led the Father of Pain Medicine and the founder also of the International Association for the Study of Pain (1974), Professor John J Bonica, to inspire an explosion from understanding pain on a basic science and clinical level to interdisciplinary treatment of chronic pain.

Do you know pain management from this perspective? If not, you need to consider updating your clinical knowledge on pain management. If you already have an appreciation of this, are you up-to-date with what is latest? To assist you, see MedRN’s Chronic Pain DVD for more information.

OPTIMISING the use of your pain medicines through pain medication education

On February 3, 2012 / Evidence based medication, Medication Education, Nurse Education, Pain Management, Pain Medication / Leave a comment

OPTIMISING the use of your pain medicines through pain medication education

The word OPTMISE is something I want to focus on today.

Optimise pain medication education

OPTIMISE means to ‘get the most out of’. So whether this is the nursing continuing education you receive or when you are administering a medication to a patient, are you or they ‘getting the most out of’ it?

With regards to MedRN’s current area of interest being pain medication education ask yourself the following questions and you will very quickly determine whether you are optimising the use of pain medicines for you or your patient:

Frequency of dosing – Are you having to review your patient sooner than the scheduled next dose? If you are, it will mean that the medicine is not optimised. Perhaps another formulation may be more suitable (E.G. a long acting formulation)
Effectiveness – Is it effective? – Reviewing pre and post pain levels with pain tools or by observation (E.G. an improvement in the ease in performing daily activities) or by the patient’s own report. It is important that goals are realistic in the context of the individual’s condition.
Tolerability – Are there side effects? Is it well tolerated? The balance of achieving risk versus benefit is not always an easy one. Is this medicine the best choice for this individual?

Are you able to confidently monitor your patients in these areas? The importance of continuing education for nurses in the area of pain management is vital because it is continually evolving as new evidence become available. Online medical education have wonderful resources available. But to OPTIMISE the use of the information gained, one must transform education into practice. MedRN’s e-book entitled: Transforming Evidence into Practice is a practical discussion which will help you do this. Also take a look at MedRN’s DVD series on The Management of Chronic Pain – A Nursing Perspective a wonderful resource to keep in your library.

A great resource to help nurse practitioners in particular with OPTIMISING the use of medicines can be found at the National Prescribing Service. The course entitled: The Medicinewise Practitioner is fantastic resource.

LEARN, RE-LEARN and OPTIMISE!!

Pain Education in Nurses – What progress have you made?

On February 2, 2012 / Pain Management, Pain Medication / Leave a comment

Whilst researching articles relating to pain education and its relevance to nursing staff, I came across a 1997 (J Pain Symptom Manage. 1997 Sep;14(3):175-88) article which looked at whether knowledge about pain management within the nursing professionhas improved over two decades. Are we still in the same spot or have we moved forward?

Medication Education for Nurses: Are we at the same spot or have we progressed??

Generally the article reported an improvement in pain assessment, opioid dosing and monitoring of addiction have occurred however there is still much room for improvement. It was concerning that less than one-half of the nurses understood that the patient’s self report of pain is a reliable indicator of pain and that the nurse should increase a previously safe but ineffective dose of opioid.

So in today’s setting,

How relevant is pain education in nurses? VERY
Where should it be prioritised? Highly prioritised
When should this education begin? As early as possible in a nurses’ career

The article went on to support the importance of using evidence based educational material on a continuing basis so that you stay updated with the latest. There is little gained and often danger in practicing with old techniques or with dated theories.

Now, ask yourself, has your knowledge in the management of persistent pain progressed?

See : http://medrn.com.au/chronic-pain-dvd-series/ for more information on how to improve your knowledge in this area.

MedRN’s DVD series on The Management of Chronic Pain – A Nursing Perspective can help you bridge this knowledge gap.

MedRN are here to help you move forward.

Archive for the ‘Pain Management’ Category

TGA warns about paracetamol use ….even at therapeutic doses!

Digesic and Doloxene to Stay! TGA overuled by AAT

Can a secondary dressing be used to secure an opioid transdermal patch?

Question: If an opioid transdermal patch (Norspan or Durogesic) does not adhere can I secure it with a secondary dressing?

Answer :

Question: If a fentanyl patch comes off or becomes loosened before a scheduled patch change, can it be replaced with a new one?

UPDATE ON THE LATEST – AAT ruling: Di-Gesic and Doloxene to remain…..For now!

Integrating people, policies, science and education…..The Australian Pain Society – 32nd Annual meeting is COMING!

Meeting A Need…..

OPTIMISING the use of your pain medicines through pain medication education

Pain Education in Nurses – What progress have you made?

Subscribe to our Newsletter

MedRN Courses

Join MedRN on Facebook

MedRN is endorsed by

Testimonial

Recents Articles on MedRN