The Pelican News - March 2018

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Page 4 • Pelican News March, April, May 2018 The Opioid Overdose Epidemic: A State of Emergency Cynthia York, DNP, RN, CGRN, FRE As Louisianans, when we hear the words “state of emergency,” we may think of weather related events like hurricanes and flooding. However, a different type of storm, deaths from opioid overdose, is leaving an alarming path of destruction across our state. According to the Centers for Disease Control (CDC) (2014), unintentional deaths from opioids now exceed automobile fatalities and occur twice as often as deaths from murders. The Louisiana Department of Health (2017) reported the number of deaths from opioid overdose had risen from 155 in 2012 to 305 in 2016. Consumption of natural and semi-synthetic opioid analgesics, including Oxycodone and Hydrocodone, have consistently resulted in the highest number of deaths, followed by heroin, synthetic opioid analgesics (excluding Methadone), Fentanyl, and Methadone. In 2015, the number of opioids prescribed to Louisiana residents exceeded the total population. Furthermore, the state had the “highest prescription-per-capita rate in the country at 1.03 pain killer prescriptions written per Louisiana resident” (Guidry, 2016, page 1). The CDC (2016) reported Louisiana had experienced a 12.4% rise in drug overdose death rates from 2014 to 2015. Parishes with the highest number of deaths due to drug overdose in 2015 included Jefferson (77), St. Tammany (47), Orleans and East Baton Rouge (27) and Washington (10). Jefferson and St. Tammany parishes remained at the top of the list in 2016 with opioid overdose deaths totaling 83 and 50, respectively; however, it is noteworthy that the number of opioid overdose deaths in the parishes of Livingston and Rapides more than doubled from 2015 to 2016 (Louisiana Department of Health, 2017). In response to the opioid overdose epidemic, the Louisiana State Nurses Association (LSNA) formed a work group of Jessica Adams, MSN, APRN, FNP-BC, AGACNP-BC, New Orleans District Nurses Association; Melody Eschete, DNP, RN, APRN-C, Feliciana District Nurses Association; and Karen Loden, MN, RN (Ret), Valerie Schluter, RN, PhD and Cynthia York, DNP, RN, CGRN, FRE, all from the Baton Rouge District Nurses Association. The work group, identified and recruited by Patricia LaBrosse, RN, PMHCNS-BC, LSNA Director of Health Policy, Clinical Practice, and Workplace Advocacy, has been charged with developing a series of position statements to be published by the LSNA that increase public awareness of the opioid crisis. Topics of interest include prevention, prescribing practices, anti-stigma, over dose reversal, and available community resources. References: Centers for Disease Control and Prevention (2014). Policy impact: Prescription painkiller overdoses. Retrieved January 4, 2018 from http://www.cdc.gov/homeandrecreationalsafety/ rxbrief/, 1-9. Centers for Disease Control (2016). Drug overdose death data. Retrieved December 12, 2017 from https://www.cdc.gov/ drugoverdose/data/statedeaths.html. Guidry, Leigh (2016). Louisiana has more opioid prescriptions than residents. Retrieved January 9, 2018 from http:// www.wwltv.com/news/health/louisiana-has-more-opiodprescriptions-than-residents/328637722. Louisiana Department of Health (2017). Opioid-related deaths in Louisiana. Retrieved December 12, 2017 from http://ldh. la.gov/assets/opioid/NumberofDeathsWithOpioids.pdf. Nursing Workforce: Ortho Not Other Campaign Charla B. Johnson, MSN, RN, ONC For the last 29 years, I have selected Other as an option for my clinical practice area on the annual nurse licensure renewal survey. I would write or type in my specialty area as Orthopaedics and would quietly sigh and be dismayed that it was not identified as a specialty. With the aging population in the United States (U.S.), the burden and magnitude of musculoskeletal disease and disabilities is increasing and impacting the utilization of healthcare resources accounting for 18% of all health care visits. Musculoskeletal conditions (diseases, disorders, injuries related to bones, joints and muscles) are the leading cause of disability and driver of healthcare costs in the US. 1 in 2 adults are affected by musculoskeletal conditions, twice the rate of chronic heart and lung conditions. 1 From 2013- 2015, an estimated 54. 4 million US adults (22.7%) annually have a doctor diagnosed form of arthritis. 2 Lower extremity total joint arthroplasty (TJA), is one of the most frequently performed procedures in the US with nearly 1,000,000 procedures performed annually. This number is projected to rise to over 4,000,000 per year within the next two decades. 2 Each year over 300,000 people, 65 years and older are hospitalized for hip fractures, most of these are related to a fall. In 2015, costs for falls to Medicare alone totaled over $31 billion. 3 Orthopaedic nurses are more challenged than ever to deliver safe, quality patient care to patients with musculoskeletal conditions and to provide health promotion as well as injury/illness prevention in communities. Management and treatment of the patient with musculoskeletal conditions in a variety of settings requires specialized knowledge and care to optimize quality outcomes, prevent complications, and lower cost. In May, 2017, I was elected as a Director to the Executive Board of the National Association of Orthopaedic Nurses (NAON) and attended my first board meeting. There was discussion on the challenge in identifying the specialty nursing workforce to meet the educational and research needs of providers. We had a brief discussion on an “Ortho Not Other” campaign to state boards of nursing. It is imperative that we are proactive in assessing the current and future demand for nursing workforce in specialty areas to include Orthopaedics in order to ensure improvement in health and healthcare outcomes in our nation and states. NAON is committed to advancing the art and science of orthopaedic care. NAON supports the development and implementation of evidence based programs that focus on bone and joint health and provides nurses with related education on the prevention and care of injuries/illnesses as well as funds nursing research. In an effort to explore the challenges and response to this type of request, In June, I contacted Dr. Karen Lyons, Executive Director for Louisiana State Board of Nursing (LSBN) and Dr. Cynthia Bienemy of the Louisiana Nurse Center with a case for a cause, the data collection and assessment of specialty care, and a recommendation to add Orthopaedics as an option to select for major clinical practice area instead of Other on the annual licensure renewal. It was a simple pitch followed by a question, “Can you tell me what it would take to make this happen on our own State survey for statistics? I would love it if Louisiana is the first to make such a statement.” There were a few emails exchanged with some possible technology obstacles but a promise to take before the Board with this initiative. The NAON Board has drafted a letter and will be seeking the assistance of the National Council of State Boards of Nursing with the same endorsement and recommendations, Orthopaedics as an option to select for major clinical practice area instead of Other on each states annual licensure renewal. I am pleased to announce that Louisiana is the first in the nation to add Orthopaedics in the clinical practice area on renewal survey. 49 to go!!! I would like to offer a special thanks to the Louisiana State Board of Nursing, Dr. Karen Lyons and the collaborative efforts of Dr. Cynthia Bienemy with the Louisiana Nursing Center. 1. Bone and Joint Initiative (2016). Executive summary of the burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost. (3rd Ed). Retrieved from http://www.boneandjointburden.org/ docs/BMUS%20Executive%20Summary%202016%20 %282%29.pdf 2. Barbour, K.E., Helmick, C.G., Boring, M., & Brady, T.J. (2017). Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation — United States, 2013–2015. Morbidity & Mortality Weekly Report, 66, 246–253. doi: http://dx.doi. org/10.15585/mmwr.mm6609e1 3. McLawhorn, A. S., & Buller, L. T. (2017). Bundled payments in total joint replacement: Keeping our care affordable and high in quality. Current Review of Musculoskeletal Medicine, 10(3), 370-377.doi: 10.1007/ s12178-017-9423-6. Retrieved from https://www.ncbi. nlm.nih.gov/pmc/articles/PMC5577424/ 4. Burns, E.B., Stevens, J.A., & Lee, R.L. (2016). The direct costs of fatal and non-fatal falls among older adults— United States. Journal of Safety Research, 58, 99-103. doi: 10.1016/j.jsr.2016.05.001 JOIN OUR GROWING TEAM! Fulltime Registered Nurse Positions: New Inpatient Surgery Unit Medical/Surgical | Emergency Department ($5,000 Sign On Bonus) ***Competitive Pay with Generous Benefit Package, including an Exceptional State Retirement Pension Plan*** Apply online at www.iberiamedicalcenter.com. Apply in person or mail resume to 2315 East Main Street, New Iberia, LA 70560. Fax resume to (337) 374-7655.
March, April, May 2018 Pelican News • Page 5 LSBN Update LSBN has recently reorganized the Executive Leadership Team with the appointment of 3 Chief positions. Dr. Jennifer Wright was promoted to Chief Nursing Officer and supervises a Division that includes Advanced Practice, RN Practice and Credentialing, Licensure and Education and the Center for Nursing. Dr. Wright is a Family Nurse Practitioner and graduated from Southeastern Louisiana University with her BSN, Northwestern State University with her MSN-FNP and Loyola University New Orleans with her DNP. Ms. Isonel Brown was promoted to Chief Administrative Officer and supervises a Division that includes Finance/Accounting, Human Resources, Information Technology, Training/ Professional Development and Security. She has double Masters’ degrees from LSU in Business Administration and Vocational Education. Ms. Wanda Woods-Matthews was promoted to Chief Regulatory Officer and supervises a Division that includes Investigations, Hearings and the Recovering Nurse Program/Monitoring. She received her bachelor’s degree from Houston Baptist University in business administration/marketing and has a Master of Public Administration from LSU. After 18 months and many challenges including the great flood of 2016 and Hurricane Harvey and other weatherrelated incidents in 2017, LSBN has finally completed its renovation and remodeling and staff are back in the newly refurbished offices. To celebrate the milestone, we had a Grand Re-Opening on December 14, 2017 preceding the regularly scheduled Board meeting. Keynote speaker was Representative Dustin Miller, Family Nurse Practitioner, and he spoke with great affection about his chosen profession and its impact on improving health outcomes in Louisiana. Representative Miller also recognized and applauded LSBN for the diversity represented by staff and Board members. The ceremony and Open House was attended by leaders from both the nursing community and other health profession organizations. All Staff Rep. Dustin Miller Why are Nurses Suing the EPA? How is it that our shampoo can contain carcinogens and our floor cleaner reproductive toxicants? For over a decade nurses have been working with a wide range of partners, including other health professionals, environmentalists, and health-affected groups, to up-date the nation’s chemical safety policy. Written in 1976, the Toxic Substance Control Act was an ineffectual safety net for people and the environment from exposures to toxic chemicals in our air, water, food, and products. It did not require companies to do any sort of pre-market testing of their products for toxicity or potential harm. Worse, it established that any chemicals that were already in the market place (some 80,000 chemicals) were “generally regarded as safe” without any evidence about their safety or harm to confirm this assumption. This was a way in which to “grandfather” a host of toxic chemicals and thus protect them from new requirements for safety testing. Additionally, the burden of proof regarding toxicity was the responsibility of the public and the Environmental Protection Agency, rather than requiring manufacturers to prove that a chemical or product is safe before letting us use the product in our homes, schools, or workplaces. In every instant in which the EPA tried to prove that a chemical was dangerous, the industry prevailed in keeping it on the market. An example of the challenges under the original law, the EPA could not even ban asbestos – a know carcinogen with unquestionable evidence of harm. In 2016, after making significant and debilitating compromises, we (nurses and others) helped to usher in a new chemical law, passed by a Republican Congress and signed by President Obama that replaced the 1976 law. The biggest and most important compromise of the new federal law is the fact that it pre-empts states from passing chemical safety laws that are more effective than the new federal law once a chemical is under review by the EPA. Historically, we have looked to progressive states to pass legislation on health and safety before federal laws have made their way through Congress and to the President. This exception flies in the face of Republican calls for increasing state’s rights over federal mandates. Instead, we now have states incapacitated from further protecting their citizens from toxic chemicals, even if their citizens overwhelmingly want the added protection. Another problematic issue with the new chemical safety law is the time line that was created for reviewing potentially, and often known, toxic chemicals. Only 10 new chemicals are required to be reviewed in the first year and then by 2019 twenty chemicals need to be under review at any given time. The Registry for Toxic Effects of Chemicals includes over 150,000 chemicals for which there is some toxicological evidence; over 80,000 chemicals are in the market place. Think about how many years it will take to get through that list at a pace of 10 - 20 chemicals per year. And, more importantly as nurses, consider how many years and decades we may see preventable health effects from toxic chemicals that have not been reviewed because we just haven’t gotten to them yet. As a nurse, whose mantra is “evidence-based practice,” I find it difficult to help individuals and communities navigate the necessary purchasing decisions required to live, work, learn, and play because of the lack of information about so many of the chemicals that make up our everyday products. Because we don’t require complete labeling for the vast majority of products, we can’t even do our own independent literature searches regarding the ingredients. When nurses started working on the revamping of the old chemical law, we had 3 elements that our coalition members agreed upon: 1) We need basic health and safety information on all chemicals in the marketplace, 2) We must be able to protect the most vulnerable of our population, including the fetus, infants, and children, from the effects of toxic chemicals, and 3) The EPA must have the power to ban chemicals that create the greatest risk of harm. Our new chemical safety law, which has a very long name and honors the original Senator who sponsored the bill, is called the Frank R. Lautenburg Chemical Safety Act for the 21st Century. Once signed into law in 2016, the EPA was mandated to issue guidance documents for how they were going to review the chemicals under the updated regulation. Unfortunately, the EPA is now under a different and admittedly anti-regulatory administration. The new guidelines, issued in June 2017, reflect this bias. Instead of looking at all possible uses of a chemical in the marketplace and commerce, the new guidelines allow the EPA to pick and choose which uses they will consider when determining if the chemical poses an unreasonable health risk. Consider the case of lead. Lead can be found as a contaminant in air, water, food, toys, and even in lipstick. If they only look at one or two of these sources, the EPA may be missing important exposure sources that could underestimate the health risks and allow a toxic chemical to be used in products that would otherwise be deemed unsafe. At the issuance of the new guidelines, nurses joined a number of other organizations in suing the EPA for placing the public at an unreasonable health risk. “The new guidelines fly in the face of our attempts to protect the public’s health,” asserts Katie Huffling, Executive Director of the Alliance of Nurses for Healthy Environments. Three separate suits were filed in District Courts around the country. It is anticipated that the judges in the courts will consolidate the cases and there will be one case heard. To follow the court case and other information about chemical safety and chemical policy, you can go to www. saferchemicalshealthyfamilies.org. To join in free monthly national calls with other nurses who are concerned about chemicals and public health policy, go to the website of the Alliance of Nurses for Healthy Environments: https://envirn.org/policy-advocacy/. With so many policy changes occurring – in health care, the environment, and other important areas - it is sometimes difficult to keep up. We welcome you to join our calls and just listen, if you like, to hear from nurses who are engaged in helping to protect human and environmental health. We also, especially, invite you to get involved and join a growing number of nurses who are concerned about potentially toxic chemicals in our everyday lives. Author: Barbara Sattler, RN, MPH, DrPH, FAAN, Professor, University of San Francisco School of Nursing and Health Professions (bsattler@usfca.edu) and Board Member of the Alliance of Nurses for Healthy Environments (www.enviRN.org) (Permission to publish and republish.)
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