Document Type


Publication Date

Spring 3-19-2021


The U.S is currently experiencing an opioid epidemic because of the number of people that died from an opioid overdose. An estimated 10 million people aged 12 or older misused opioids in 2019. Studies have shown that applying a systematic method for risk stratification for all patients considered for opioid therapy could be vital to screening patients at risk for opioid misuse to ease the opioid epidemic. Based on the assumption that the Diagnosis Intractability Reliability Efficacy (DIRE), an opioid risk assessment tool, would substantially change the providers’ prescribing decisions, it was implemented in an Acute Pain Service. Purposive sampling was used to recruit eleven Nurse Practitioners from an Acute Pain Service (N=11). Data was collected 9-weeks retrospectively and then for 10- weeks during the project implementation. A post-implementation survey was completed to obtain feedback about the DIRE. The relationship between providers’ initial and final decision to initiate long-term opioid therapy or refer the patient to an addiction specialist was not statistically significantly different. The relationship between patients’ risk level and providers’ decision to initiate long-term opioid therapy or refer the patient to an addiction specialist was statistically significant. Providers did not initiate long-term opioids when patients’ risk level was high, and providers referred patients to an addiction specialist when their risk level was high. The percentage of long-term opioids initiated during the 10-weeks of project implementation decreased compared to 9-weeks before the project implementation. The providers’ perception of the DIRE was that the majority thought it was easy, helpful, and served as a guide to making the difficult decision to start long-term opioids. This project revealed that the DIRE served as a validation of the providers’ initial assessment and interventions. The DIRE could help to promote patients’ safety and support the safe prescribing practice of long-term opioids.

Keywords: DIRE, long-term opioid, opioid risk assessment tool

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