title: Effects of an opioid taper algorithm in hematopoietic progenitor cell transplant recipients.
abstract: OBJECTIVE
  To examine the effects of an opioid taper algorithm on the length of taper, pain levels, withdrawal symptoms, and satisfaction with pain management in hematopoietic progenitor cell transplant (HPCT) recipients and nurse documentation of patient response to taper.
  
  
  METHODS
  Quasi-experimental.
  
  
  METHODS
  A 32-bed HPCT unit in a large tertiary U.S. healthcare center.
  
  
  METHODS
  106 HPCT recipients, 5-64 years of age.
  
  
  METHODS
  In phase 1, baseline data were collected from 45 patients during opioid tapers, with no study intervention. In phase 2, an opioid taper algorithm was implemented as the study intervention for 61 patients.
  
  
  METHODS
  Phase 1 and phase 2 pretaper and taper opioid dosage, length of taper, nurse documentation, patient-reported pain and withdrawal symptoms, and nurses' perspectives about the use of tapers.
  
  
  RESULTS
  Use of the algorithm in phase 2 resulted in decreasing taper time by a mean of 0.4 days, a significant decrease in withdrawal symptoms, a significant increase in only 1 of 10 aspects of nurse documentation, and no significant differences in patient self-reports of worst pain or satisfaction with pain management. Nausea, vomiting, diarrhea, insomnia, and runny nose were the withdrawal symptoms reported most frequently.
  
  
  CONCLUSIONS
  Use of the algorithm improved tapering practice somewhat without disadvantaging patients.
  
  
  CONCLUSIONS
  Use of an opioid taper algorithm may promote consistency of tapering practice.
authors.affiliation: Fairview-University Medical Center, Minneapolis, MN, USA. lparran1@fairview.org
authors.forename: Leslie
authors.initials: L
authors.lastname: Parran
authors.forename: Carol
authors.initials: C
authors.lastname: Pederson
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000451:nursing; D010147:Pain Measurement; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control; D013810:Therapeutic Equivalency; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone; D005283:Fentanyl