Decreasing Opioid Utilization in Rehabilitation Patients Using a Clinical Nurse Specialist Pain Consultant Program

Abstract Objective To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization. Design Retrospective chart review of patients discharged during 6 months prior to and 6 months after introduction of the CNS role. Setting Not-for-profit 98-bed community inpatient rehabilitation hospital. Participants Two population-based samples of adult, inpatient rehabilitation patients (N=72) with daily opioid use ≥30mg morphine equivalent dose (MED) per day on admission and length of stay ≥24 days. Interventions Implementation of a CNS pain consult program. Main Outcome Measures Change in average daily opioid use (milligrams of MED per day), measured at admission, week 1, week 2, and week 3. Results Linear mixed modeling was used to estimate individual and group average opioid trajectories, including individual patient intercepts (opioid use at admission) and slopes (change in opioid use over time). There was a significant interaction between group and time ( b =5.75, t =2.52, P Conclusions Addition of a CNS pain consultant program to an inpatient rehabilitation hospital supported a distinct pattern of opioid tapering that promoted more rapid titration of daily opioid use across the rehabilitation hospitalization.