Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2019


Doctor of Nursing Practice (DNP)

Primary Advisor

Joyce Pulcini, PhD, RN, PNP-BC, FAANP, FAAN; Kate Malliarakis, PhD, ANP-BC, MAC, FAAN


Background: Concerns about opioid prescribing in the United States have been rising (Centers for Disease Control and Prevention [CDC], 2016). Assessing pain scores, along with urine toxicology screenings can provide information to both patients and providers about prescription opioids.

Objectives: The purpose of this retrospective chart review study was to compare numeric pain scores and urine toxicology results between two different groups of patients who were being prescribed daily≥ 90mg opioid dosing.

Methods: This retrospective chart review sample was of 134 adult chronic pain patients at one pain management clinic. Patients’ average numeric pain rating while using opioids for a year in the≥ 90mg daily opioid dosing group at initial visit and after a year on opioids were analyzed. Urine toxicology screening results were analyzed.

Results: Of the 134 patients, 9 (6.7%) failed urine toxicology screenings, 6 from the (group) and 3 from the (≥90mg MED high dose group). Of 134 patients, n=77 (57.5%) improved their pain score in the year, n=57 (42.5%) had no improvement or worse pain on opioids. Insurance type: of the 134 patients, Medicaid 32.1% (n=43), Medicare 29.1% (n=39) Workers Compensation 19.4% (n=26), and private insurance 18.7% (n=25).

Conclusions: This study indicates insurance type was a statistically significant variable and indicates further research is needed within the two dosing groups to understand how this may influence changes to opioid prescribing. Urine toxicology failures between both dosing groups was only 6.7%.

Open Access


Included in

Nursing Commons



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