Learning Objective #1: enumerate patient and staff benefits of eradicating postoperative parenteral use of narcotics in the care of total hip and knee patients.

Learning Objective #2: identify "growing pains" multidisciplines experienced in implementing the updated pain management pathway and the objectives attained as a result of collaborative work.

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The challenge of providing evidence based treatment to patients requiring total hip and knee replacements must keep pace with the increased public demand for quality care in a timely fashion.  Rising technology costs in combination with increasing volumes of aging patients requiring joint replacements encouraged our interdisciplinary team to work collaboratively and innovatively to address the needs of this patient population. The team observed that the traditional narcotic management of the postoperative orthopedic patient appeared to prolong their length of stay and exposed the patient to medical complications.  Therefore, to improve clinical, quality, and fiscal outcomes, a multidisciplinary task force was created whose objective was to improve patient satisfaction, functional ability, and early discharge. Pathways were implemented that improved care however results were inconsistent and not sustainable.  The team refocused its efforts on addressing the management of a patient’s pain postoperatively as this appeared to be the primary issue preventing the patient from engaging in recovery activities. The postoperative pathway was changed to support the preemptive management of pain and to eradicate complications related to narcotic use. 
Following the initiation of the revised pain management protocol, a 120 retrospective chart review revealed fewer episodes of nausea and vomiting, elimination of incidences of respiratory depression, ileus, and narcotic-induced hypotension. The elimination of parenteral and transdermal narcotics resulted in a reduction in the average cost per case and at discharge, patients’ functional level, length of stay, satisfaction, and cost per case were all improved.
This patient care improvement initiative demonstrated how a multidisciplinary team approach focused on collaboration had a positive impact on improving the care, cost, and satisfaction of this patient population.