Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Mary Ann Camilleri

Second Advisor

Joan A. Kearney


Abstract End of life (EOL) symptom management is the cornerstone of hospice care. Hospice patients, especially advanced cancer patients, have an increased need for pain and symptom management towards end of life. For those patients at EOL, opioids are the mainstay treatment to relieve intractable and breakthrough pain. Due to opioid regulatory changes over the past few years, there has been more confusion than clarity among the hospice & palliative care practitioners prescribing opioids for EOL pain management. Healthcare practices across the country are realigning their policies to the opioid prescription rule changes. It is imperative for hospice providers to translate federal and state opioid regulations into organizational policy to guide hospice & palliative care practice. The purpose of this project was to review, synthesize and reconcile federal, state, and local opioid regulations and create a system for a sustainable data base in order to develop and maintain opioid policies for implementation in multi-site hospice organization, across 35 states, to ensure ongoing compliance with opioid laws. The cyclic process of the KTA framework was used for the project that places creators and users within a system which is dynamic as well as adaptive, so that as the opioid regulations change, the policy and protocols will be modified and re-adopted. An umbrella opioid medication policy, and state specific guidance was developed. Results show that, 4 weeks after policy dissemination, 32 out of 35 states continued to maintain 100% clinician compliance with the umbrella opioid medication policy, and state specific guidance. There was a 50% reduction in opioid-related events. This DNP project has applicability to further compliant opioid practice in a variety of care settings nationwide. Keywords: End of life, Hospice, Opioid, Pain, Regulatory Compliance.


This is an Open Access Thesis.

Open Access

This Article is Open Access