Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Julie A. Koch


The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documenting medical necessity, and e adjusting treatment in response to clinical changes are essential. National and state guidelines recommend that patients on chronic opioid therapy (COT) should periodically undergo urine drug testing and a review of prescription drug monitoring program to confirm adherence to the treatment plan. These guidelines also recommend reviewing the prevalence and pharmacologic consequences of BZDs among patients on COT. This DNP Project evaluated the effectiveness of the implementation of a quarterly triad tool (QTT), which included (a) current urine drug testing and (b) prescription drug monitoring, with (c) the addition of medication reconciliation for concomitant BZD use (CBU) on mitigation of adverse event risks in patients treated for chronic pain in a pain clinic in central Indiana. One of six providers did not adopt the practice change; but 151 of 154 patients were screened using the QTT, and 24 (15.89%) had CBU detected. Documentation of risk education increased from 25% pre-intervention to 100% post-intervention (X2(1) = 10.59, p = .001). Follow-up plan documentation also increased to a statistically significant level: 5% pre-intervention to 75% post-intervention (X2(1) = 8.24, p = .004).