NMAHP RDI Fellow - Alison Blackburn - Newcastle Hospitals NHS Foundation Trust

Alison Blackburn, Lead Nurse for the inpatient pain service at the RVI has been awarded a Chief Nurse Post-doctoral Fellowship through Newcastle’s innovative Nursing, Midwifery and Allied Health Professionals (NMAHPs) Researcher Development Institute (RDI).

Supported through funding by the Newcastle Hospitals Charity, Alison’s fellowship provides protected time for two dedicated research days per week and will allow her to pursue a research study exploring opioid stewardship on behalf of and with support from our Executive Director of Nursing Ian Joy.

More specifically Alison aims to develop and implement a management strategy for the safe and effective use of acutely prescribed opioids.

This will be supplemented by guidelines offering advice and support for both patients and healthcare professionals to help them optimise opioid use, whilst minimising longer term use to prevent dependency and significant associated risks.

Alison’s fellowship will take place for a period of one year and will focus on a qualitative study to explore the needs and wishes of GP practices around opioid discharge information as well as a health economics assessment.

She will also map out the interface between opioid prescription at discharge together with the information and ongoing support provided to patients and GPs.

The challenge

Opioids are regularly prescribed for all types of pain; they are particularly effective for the treatment of severe acute pain (IASP 2018), and current guidance recommends that opioids should not be continued beyond the expected period of healing (RCoA 2017).

Longer term opioid use is associated with an increased risk of opioid use disorder, addiction, overdose, and death (Dowell 2016). The North of England has the largest number of opioid prescriptions per patient (ONS 2021).

Long term opioid use frequently begins with the treatment of acute pain (Shah et al 2017) particularly if a large supply is provided at discharge (Deyo et al 2015).

Pressures for earlier discharge from acute hospitals regularly result in patients being discharged with a supply of opioids (Ruder et al 2017).

Guidelines for the use of opioids have been available in the UK for many years and have had little impact on the increasing use of opioids (RCoA 2017).

They suggest that information on tapering and stopping the use of opioids should be discussed with patients, along with both known benefits and risks, and that the provision of written advice to patients and GPs should be routine.

Exploratory findings

A recent study conducted within the Trust explored the factors that influence the decision to prescribe opioids in an acute setting as well as the factors that influence patients to take opioids. It also reviewed the information provided to support those decisions.

Alison explains what they found “The healthcare professional and patient factors identified within our local context suggest that patients are confident that opioids are safe based on the premise that they were prescribed by experts, and stopping opioids will be straightforward. Yet no written information is currently provided to guide them on how to manage their opioid use.

“Furthermore many healthcare professionals said that whilst they believed opioid stewardship was an important part of their role, it was not as yet embedded in practice and therefore not routinely carried out.”

Alison plans to use her fellowship to design, develop and establish a multi-factorial intervention to support both the patient and the healthcare professional in the successful management of safe and effective, short term use of opioids for acute pain.

Increasing research impact whilst strengthening academic links

Because of the positioning of Alison’s Fellowship within the RDI, she will also be able to access support through the RDI Fellows forum and the Newcastle Health Innovation Partners (NHIP) Academy, on behalf of the Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University and Northumbria University.

Alison says she is delighted to been awarded the Fellowship and is looking forward to taking her research forward in collaboration with a number of like-minded clinical academics.

“There is lots of support available here in Newcastle for my project which is great news. Colleagues at Newcastle Health Innovation Partners (NHIP) have helped to facilitate the continuation of my honorary research associate status at Newcastle University, and I will be able to network via their forums which adds to breadth of knowledge.

“I’ve also been introduced to health economist, Joanne Gray at Northumbria University who will be collaborating on the project, and I’m working with the medicine optimisation team within the North East and North Cumbria Integrated Care Board.

“Such multi faceted partnership working across the region brings so many strengths and experience, and I’m excited to have the opportunity to tap into such a wealth of expertise which will ultimately help me to drive this project as successfully as possible.”

Associate Director for Nursing Anna Telfer congratulated Alison on her Fellowship. “Alison’s work and leadership around opioid stewardship is so important to the Trust and a significant aspect of the patient safety agenda.

“By backfilling two days a week of her clinical role, the Researcher Development Institute’s support has created the capacity Alison needs to carry out her post-doctoral studies whilst remaining firmly embedded in clinical practice. Congratulations Alison!”

Alison’s journey into research

Alison explains how her research journey started when she was briefly a research delivery nurse. She became interested in all aspects of research at that time, but particularly how to develop her own research interests and subsequently completed an MSc in research design.

“I have always chosen to stay within a clinical role and incorporate research, as I see the two aspects as being intertwined,” explains Alison. “It was whilst developing the role of nurse specialist within the pain service that I completed a PhD, undertaking a narrative analysis of the experiences of living with low back pain.”

Alison currently leads the nurse specialist inpatient pain service at the RVI has had the opportunity to continue to develop the research element of her role along with the clinical and educational leadership aspects.

“Nursing is an extremely complex, safety critical profession and as such relies on research”, says Alison. “As a post-doctoral clinician, I am committed to developing research opportunities for myself, for my clinical team and for the wider organisation.

“Whether you are a new graduate, an experienced nurse, an academic or educator, research is paramount to each role and should be encouraged and nurtured so that every nurse is confident and able to incorporate research, indirectly or directly, into practice”.