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Saturday, 29 October 2011
Learning Objective 1: Discuss three ways that analgesic gaps occur during the perioperative period for the chronic pain patient on sustained-release or long acting opioids.
Learning Objective 2: Discuss how chronic pain patients are managed during the perioperative period at York Hospital in York, PA based on the recommendations of this EBP project.
Practice Question: Identify if prescreening the chronic pain patient before the day of surgery is safer and would increase patient satisfaction with pain control. Background: There is no standardized approach to managing perioperative pain in the chronic pain patient on sustained-release opioids. A pre-anesthetic interview is done by telephone before surgery to verify the patient’s health history and identify medications. The anesthesiologist reviews the assessment on the day of surgery and provides analgesics according to their preferences. Analgesic gaps are created if the patient omits their morning pain medicine, the anesthesia provider doesn’t compensate for the missed doses, and the surgeon writes a postoperative analgesia order that doesn’t consider their patient’s chronic pain condition. The patient may be dissatisfied with the pain management received during the surgical visit and is at risk for withdrawal symptoms if treated the same as an opioid-naïve patient. EBP Model: The Johns Hopkins Nursing EBP Model. A literature search produced 42 articles which were narrowed to 2 (Level 4 A/B) clinical practice guidelines and 10 (Level 5 A/B) reviews. Results: Identifying chronically opioid-consuming patients is the responsibility of the entire perioperative team. Preoperative evaluation is necessary to document daily opioid use and plan perioperative pain medicine management. Practice Recommendations: Pre-hospital nurses can identify surgical patients on chronic opioid therapy using sustained-release opioids. A sticker placed on the inside cover of the patient’s chart will remind the anesthesia provider and surgeon that the patient is on chronic opioid therapy, to expect higher perioperative opioid usage, and to take the patient’s baseline requirements into consideration as well as acute pain. A pain management reference guide and pain team consult form can be included in the chart to assist the surgeon in writing appropriate and safe postoperative orders. Recommendations went into effect in October 2010.