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Opioid tapering in hematopoietic progenitor cell transplant recipients
1School of Nursing, University of Minnesota, Minneapolis, USA. peder001@tc.umn.edu
Purpose/Objectives:
To describe current opioid-tapering practice, patient pain levels and withdrawal symptoms, and nurse documentation during opioid tapers.
Design:
Descriptive, exploratory, prospective, quantitative, and qualitative.
Setting:
A 32-bed blood and marrow transplant unit in a large, tertiary U.S. care center.
Sample:
45 blood and marrow transplant recipients between the ages of 7-64. Types of transplant were autologous, allogeneic, and unrelated donor marrow; peripheral blood stem cell; and umbilical cord blood.
Methods:
In daily interviews, patients reported pain levels and withdrawal symptoms during opioid tapers. Demographic, medication, and nurse documentation data were obtained from patient hospital records.
Main Research Variables:
Taper length, daily opioid dosage, pain, withdrawal symptoms, and nurse documentation.
Findings:
Length of taper ranged from 1-17 days (X = 6.53, SD = 4.26). Analysis of variance indicated no difference by disease or transplant type in length of taper, cumulative opioids given pretaper or during taper, or number of self-reports of withdrawal symptoms. Daily changes in nurse-administered opioid dosage during tapers ranged from a decrease of 67% to an increase of 14%. Children received significantly more opioids/kg during taper than adults. Means of adults' and children's self-reports of pain were low. The means of patient-reported withdrawal symptoms were highest on taper days two through six. Nurse documentation was sparse.
Conclusions:
Daily taper rates vary widely, pain is well managed, and most patients experience several withdrawal symptoms.
Implications For Nursing Practice:
Use of an opioid-taper guideline may promote consistency of tapering while not increasing levels of pain or withdrawal symptoms.