how we treat acute pain really matters

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Post on 07-May-2015

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After surgery, an Acute Pain Service centered on Continuous Peripheral Nerve Blocks allows the avoidance of narcotics, hastens recovery and improves safety. Watch this brief presentation to learn more about the impact that optimized acute control can have on patient satisfaction, safety and outcomes for your hospital.

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Page 1: How we treat Acute Pain Really Matters
Page 2: How we treat Acute Pain Really Matters

GOALS OF CPNB PROGRAM Minimize Pain*

Not “Painless” surgery Minimize Side Effects/Morbidity Opioids

N/V, pruritis, constipation, sedation, confusion, hypoventilation

Improve Outcomes LOS*, PACU time*,ROM/Rehabilitate, Pt Satisfaction

Part of Multimodal Therapy NSAIDS, Ice, Opioids*

Pt Selection & Surgery Type influence the degree of goal attainment

Page 3: How we treat Acute Pain Really Matters

YOU SHOULD FEEL GOOD ABOUT THIS!!POORLY CONTROLLED PAIN

Delayed Discharge Prolonged Recovery/Return to ADL Increased Use of Healthcare Resources Patient DissatisfactionDelays in Wound HealingDisrupted Sleep & Worsened PainMorbidity & Mortality (more than you might think!)

Chronic Pain

…and this is the BEST solution !!!

Page 4: How we treat Acute Pain Really Matters

WHY SHOULD I BOTHER?

Patient Satisfaction Better experience with effective analgesia (& tell their friends) I would argue this alone is an adequate reason to pursue

Improve Safety Respiratory Depression/Airway Issues (OSA, COPD, full stomach)

Secondary Injuries (MI, CVA, blood clots, pneumonia)

Confusion/POCD* (Elderly)

Affect Outcomes Decrease Length of Hospital Stay (Faster Day Surgery & Fewer days)

Improve Early Range of Motion, Mobility & Recovery Improve Pulmonary Function Minimize Inactivity-induced Muscle and Bone Loss Decreased Persistent Pain Decreased Cancer Spread and Recurrence

Page 5: How we treat Acute Pain Really Matters

WHY SHOULD I BOTHER? Decreased Length of Stay & Acuity

Hospital $$ Savings (SIX FIGURES ON RCR ALONE) Avoid or shorten ICU stays Avoid Inpatient Events (nosocomial pneumonia)

Faster Turnover Fewer ‘slow’ wake ups Less Paid Overtime I think Surgeons like this, too

Faster Outpatient Discharge Can Skip PACU completely; drops SDS time to D/C as well Shorter PACU times; less O.R. Bottle-necking Decreased Staffing Needs for Hospital/Surgery Center

Outpatient instead of Inpatient

Page 6: How we treat Acute Pain Really Matters

WHY SHOULD I BOTHER?

Decreased Workload R.N.’s can perform job more effectively & more safely Less calls from PACU & Floor for ‘further’ interventions

Your Hospital’s Image Nationwide, pain control is still inadequate or poor Public more cases Administration more cases Surgeons more cases

Job Satisfaction YOU YOUR O.R. staff YOUR Hospital Staff

Page 7: How we treat Acute Pain Really Matters

CPNB OUTCOMES

These improved outcomes and reduced morbidities are much more likely to manifest when used in a system-wide recovery strategy.

“Importantly, there is a critical need for collaborations between the various healthcare providers involved in perioperative patient care (e.g., anesthesiologists, surgeons, nurses, & physiotherapists) to integrate improved perioperative pain management with the recently described fast-track recovery paradigms. This type of combined approach is well documented to improve the quality of the recovery process and reduce the hospital stay and postoperative morbidity, leading to a shorter period of convalescence after surgery.

P White, H Kehlet Improving Postoperative Pain Management Anesthesiology 2010;112:1:220-5

Page 8: How we treat Acute Pain Really Matters

BROADENED PATIENT SELECTIONParticular Benefit

1. OSA, especially untreated

2. Opioid-dependent?3. Opioid-sensitive4. ‘Clean’ Addict5. Elderly & Cancer pts6. Painful (2nd) Procedures7. Severe COPD/Cardiac Dz8. Risk Chronic Pain/RSD9. Full Stomach/Bad Airway10. Acute Fracture/Pain (if USG)

Particular Challenge1. Isolated – care/phone2. D.M. w/ Neuropathy (high BS & N.

Stim)

3. Evolving Neurologic Injury4. Preexisting Nerve Injury5. Anxious / Cognitive Issues6. Compartment Sd? (no cases in

literature)

7. Renal failure?/Cirrhosis/CHF8. Severe Cardiac Arrhythmia9. COPD ?10. Acute Fracture/pain (if N.Stim only)

Page 9: How we treat Acute Pain Really Matters

OPEN CHOLECYSTECTOMY

This patient had an OPEN cholecystectomy less than 24 hours ago.

He is going home with a continuous peripheral nerve block (CPNB) now.

Page 10: How we treat Acute Pain Really Matters

YOU SHOULD FEEL GOOD ABOUT THIS!!Patient WIN - analgesia, side-effects, home faster, better rehab & sleep, fewer complications, other

Surgeon WIN- happier patients, more patients, less rounding, less issues

Hospital WIN- patient satisfaction, length of stay, staffing cost, more pts, staff satisfaction, compliance, supply cost

Anesthesia WIN- image with admin/surgeons, satisfaction, collections, safety

Healthcare WIN - resource utilization, avoid complications, less cost

Page 11: How we treat Acute Pain Really Matters

BOTTOM LINE…..ONE MORE TIME

HOW WELL WE TREAT PAIN

REALLY MATTERS!!

Page 12: How we treat Acute Pain Really Matters