Effects of an opioid taper algorithm in hematopoietic progenitor cell transplant recipients.
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.
Parran
Leslie
L
Fairview-University Medical Center, Minneapolis, MN, USA. lparran1@fairview.org
Pederson
Carol
C
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
D000701:Analgesics, Opioid; D004091:Hydromorphone; D005283:Fentanyl