Date of Award

Spring 2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Flor. A Culpa-Bondal, Ph.D, APRN, PMHCNS/NP-BC

Second Advisor

Sandra Copeland, DNP, RN, CNS-BC, FNP

Third Advisor

Joy Chang, ANP-BC


The U.S is currently experiencing a deadly opioid epidemic, as demonstrated by the prevalence of opioid misuse and overdose-related deaths. Over the last two decades, opioid overdose has claimed the lives of more than 700,000 Americans; deaths increased by 200% from 2000 to 2014 (National Institute of Health, 2020), and totaled 67,367 in 2018 alone (CDC, 2020). Therefore, healthcare providers collaborating with other stakeholders must continue to explore and apply appropriate risk assessment tools to mitigate this crisis, such as a systematic method of risk stratification. This quality improvement project aims to improve current opioid risk screening practices conducted by acute pain services (APS) by introducing an opioid risk assessment tool, the Diagnosis, Intractability, Risk, and Efficacy (DIRE) Score, into clinical practice. The DIRE Score was designed to be utilized in clinical practice and expected to substantially change providers’ prescribing decisions. Purposive sampling was used to recruit the participants (N=11), APS providers from a metropolitan hospital in Atlanta, Georgia. Data was collected retrospectively, utilizing the DIRE Score and 9-weeks rounding sheet, before and during the 10-week project implementation. Lastly, a post-implementation questionnaire survey provided feedback about the DIRE Score. This research demonstrated no statistically significant relationship between provider’s initial and final plans to initiate long-term opioid therapy or refer patients to addiction specialists. However, there was a statistically significant relationship between patients’ risk level and their providers’ decision to initiate long-term opioid therapy or refer patients to addiction specialists. The percentage of long-term opioid therapy methods initiated during the ten weeks of project implementation decreased from pre- to post-assessment. The providers’ utilization of the DIRE Score increased, and the majority of providers perceived the DIRE Score to be an easy, helpful guide for making the difficult decision to authorize long-term opioid therapy, validating their initial assessment and interventions. The DIRE Score helps to promote patients’ safety and supports the safe prescription of long-term opioids.

Included in

Nursing Commons