Learning Optimal Opioid Prescribing and Monitoring: A Simulation Study of Medical Residents

Details

• Personal Author:
  Darabi H ; Falck S ; Galanter WL ; Kannampallil TG ; Lambert BL ; McNutt R ; Odwazny R ; Patterson D ; Schiff G ; Sharabiani A ; Vaida AJ ; Wilkie DJ
• Description:
  Objective: Hospitalized patients often receive opioids. There is a lack of consensus regarding evidence-based guidelines or training programs for effective management of pain in the hospital. We investigated the viability of using an Internet-based opioid dosing simulator to teach residents appropriate use of opioids to treat and manage acute pain. Materials and methods: We used a prospective, longitudinal design to evaluate the effects of simulator training. In face-to-face didactic sessions, we taught 120 (108 internal medicine and 12 family medicine) residents principles of pain management and how to use the simulator. Each trainee completed 10 training and, subsequently, 5 testing trials on the simulator. For each trial, we collected medications, doses, routes and times of administration, pain scores, and a summary score. We used mixed-effects regression models to assess the impact of simulation training on simulation performance scores, variability in pain score trajectories, appropriate use of short- and long-acting opioids, and use of naloxone. Results: Trainees completed 1582 simulation trials (M = 13.2, SD = 6.8), with sustained improvements in their simulated pain management practices. Over time, trainees improved their overall simulated pain management scores (b = 0.05, P < .01), generated lower pain score trajectories with less variability (b = -0.02, P < .01), switched more rapidly from short-acting to long-acting agents (b = -0.50, P < .01), and used naloxone less often (b = -0.10, P < .01). Discussion and conclusions: Trainees translated their understanding of didactically presented principles of pain management to their performance on simulated patient cases. Simulation-based training presents an opportunity for improving opioid-based inpatient acute pain management. [Description provided by NIOSH]
• Subjects:
  Education Health Personnel Occupational Health Safety Staff Development
• Keywords:
  Author Keywords: Pain Management Computerized Simulation Health Care Workers Medical Treatment Patient Safety Physicians Prescription Drugs Simulation Training Training Effectiveness
• ISSN:
  2574-2531
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Florida ; Illinois ; Massachusetts ; OSHA Region 1 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  246-254
• Volume:
  1
• Issue:
  2
• NIOSHTIC Number:
  nn:20063622
• Citation:
  JAMIA Open 2018 Oct; 1(2):246-254
• Contact Point Address:
  Thomas Kannampallil, Department of Family Medicine, University of Illinois at Chicago, 1919 W Taylor Street (M/C 663), Chicago, IL 60607, USA
• Email:
  tgk2@uic.edu
• Federal Fiscal Year:
  2019
• Performing Organization:
  University of Illinois at Chicago
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  JAMIA Open
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ff290de5d38053fb2c9040ddf464a785554d2e1f1eb1b3587015ae151451e81ab9211f5839cd24a783d242f8e6e389d3773638e4aecba6fb8f0a70133f40fdda
• Download URL:
  https://stacks.cdc.gov/view/cdc/222194/cdc_222194_DS1.pdf
• File Type:
  [PDF - 681.52 KB ]