By Michele Pilon
President/CNO, Transylvania Regional Hospital
September is National Pain Awareness Month, and I want our community to know that Transylvania Regional Hospital is committed to safely and responsibly alleviating pain for our patients – whether it’s temporary postsurgical pain or a chronic condition; at the same time, we’re actively fighting pain medicine abuse. As you know, highly addictive opioid pain medication is in the news daily, and not in a good way. Opioid addiction is truly a deadly epidemic gripping the nation; sadly, Transylvania County has taken a direct hit.
From a historical perspective, pain was officially named the fifth vital sign (added to heart rate, blood pressure, temperature and respiratory rate) in 1989. Physicians adopted a new pain consciousness, and pharmaceutical companies developed medications that doctors prescribed freely – after receiving assurance that certain of those medications were non-addictive. In hindsight, they were highly addictive. Currently, the drug overdose death rate is 18 percent for Transylvania County, compared to 16 percent for North Carolina, and 14 percent for the United States. As our approach to pain treatment evolves, we are working to balance addressing patients’ legitimate needs with doing everything possible to stem the horrors of the opioid crisis.
Transylvania County’s top three healthcare challenges are mental health issues, obesity and addiction. Our emergency department has preventive substance abuse measures and safeguards in place, and our Pain Clinic staff are attuned to the needs of our chronic pain patients.
Janet McCall is the TRH Pain Clinic’s Practice Manager, and she cites a multidisciplinary approach as key to treating patients struggling with chronic pain. “The surgeons or primary care [providers] see patients for short-term narcotic use. Our providers use pain pumps, nerve stimulators and spine injections to control pain, as well as other medications. We also have a psychologist in the practice who sees patients before they receive nerve stimulators and pain pumps, and treats patients if they experience depressive symptoms while on pain medicine,” she says.
McCall shares additional precautions as well: “We’re distributing drug deactivation pouches that allow patients to discard unused pain medications safely; if they place pills in a pouch and add water, the drugs are deactivated in 30 seconds. We also call patients in for random drug screens, provide narcotic pain counts with each visit and participate in the North Carolina Controlled Substance Reporting System, which tracks patients’ prescriptions from all medical sources.”
Our ED also employs methods to decrease opioid abuse and addiction. This is critical, because deaths attributed to synthetic opioids reached almost 30,000 in 2017, comprising nearly half of the nation’s 72,000 overdose death total. Our ED doctors check the NC Drug Monitoring Database before prescribing any controlled substances, in addition to prescribing alternative medications to opiates for only 4-5 days.
The TRH ED, like most EDs nationally, does not treat chronic pain. ED Team Leader Lynn Tyler, RN, CEN, CPEN, works closely with C.A.R.E. Coalition of Transylvania County, a local grassroots organization dedicated to ensuring a substance-free future for Transylvania County’s kids, and says prompt, communitywide action is necessary. “Overdose deaths rose dramatically around 2009, so we formed C.A.R.E. Coalition after holding conversations with key community stakeholders: parents and youth representatives, law enforcement, healthcare professionals, and faith communities,” Lynn says.
Tyler explains that, through this partnership, TRH offers medication lockboxes containing “Be aware, don’t share” literature to all patients who receive prescription painkillers so only they can access the medications. The ED also offers patients drug deactivation pouches described above. It works to combine preventive strategies and approaches that meet addicts where they are as well. “The hospital, C.A.R.E. Coalition and our local Health Department created a flyer for every patient discharge packet,” Tyler says, “with tips on preventing opioid abuse and deaths, like not sharing medication and proper disposal – either at the Sherriff’s Office or Police Department drop-off boxes, or by deactivation packets.”
She adds that a groundbreaking movie was screened at the public library – cosponsored by C.A.R.E. Coalition and TRH – that educated 120 attendees about the importance of building emotional resilience in our children. “The film, Resilience: The Biology of Stress and the Science of Hope, addresses PTSD rooted in adverse childhood experiences, which increases the risk of addiction in later life,” Tyler declares. “Learning about these universal factors helps us reduce the stigma around addiction.”
Although TRH is clearly “ahead of the curve” in combating opioid abuse and addiction, our culture of continuous improvement requires that we keep seeking strategies that will protect our community – Transylvania County’s future.
Michele Pilon, MS, BSN, RN, NE-BC, is the President and CNO of Transylvania Regional Hospital. Her diverse professional experience includes service as a bedside nurse and over a decade as a leader at healthcare institutions in Virginia, Florida and North Carolina. Pilon earned a bachelor’s in Nursing from Ohio’s University of Akron and a master’s in Health Services Administration from the University of St. Francis in Illinois; she is also a board-certified Nursing Executive.