VISN6Governor’sWorkGroupUpdate5/24/2018

LindaExner,ActingDeputyNetworkDirector

TheOpioidCrisis:VISN6BestPracticesandInnovations

TwoExamplesfromthe2018VA“SharkTankCompetition”ØDurhamEvidence-based interventionusingMusictoaddressthetwinepidemicsofopioid overuseandpaininVeteransundergoingsurgery.

- https://youtu.be/hpeUtvr-iCY

ØAshevilleTotalKneeArthroscopyPilot

EnhancedRecoveryAfterSurgerypathways(ERAS)CharlesGeorgeVAMedicalCenter,Asheville,NC

Outcomesv A32%decreaseinuseof

hydromorphonev Approx.21%decreasein

overallopioiduse.v DecreaseinLOS.55days

resultingin$150,000savingsinonequarterofimplementationest.annualsavings:$600,000

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April2017– May2018

IMPLEMENTATIONTOTAL KNEE ARTHROSCOPY PILOTERASIMPLEMENTATION ACTIONS:v Pre-Operative:Developedpatienteducationbooklet;includes allappointments,care,education,andfollowupVeteranisengaged;bringsbooklettoallpre-opvisitsv Intra-Operative:Opioid sparingmultimodal analgesiaAvoidtubesanddrainsIncreaseinuseofspinal andregionalanalgesiav Post–Operative:CryotherapyimplementationMultimodal analgesiaEarlynutritionEarlyPTandmobilization- PMRSseeing100%ofERASTKAVeteranspost-opday0

OUR ERASMULTI-DISCIPLINARY IMPLEMENTATION TEAMVadaCampbell, RN,InpatientPainManagementCaseManager,ERASWorkgroup Chair

SheriNorman, RN, PACU/DaySurgery,ERASWorkgroupViceChair

v SusanBazemore, CRNA, SurgeryServicesv SidneyCarter, RN, Orthopedics CaseManagerv GingerCodd, Clinical Dieticianv TamaraCornell, PT,DPT,Clinical ProgramManagerv EileenFerrell, MSN,Nursing Educationv SherryGoar,FNP,Pre-Anesthesiav AmandaGraves,RN,NurseManager,SurgicalFloorv DouglasHuntley,MD,AssistantChiefofSurgeryv JoeKelley,MD,Anesthesiologistv JillKerik, FNP,Hospitalists

v LibbyLibner, RN, Orthopedics CaseManagerv Chris Nagy,MD,ChiefofOrthopedicsv MirandaMcKinney,ClinicalDieticianv NatalieMicale,Clinical Dieticianv AngelaPadgett,CNL, SurgicalFloorv CraigPowell, MD,ChiefofSurgeryServicesv Caitlin Rawlins,RN, SurgicalFloorv TroySchmidt, MD,Orthopedic Surgeonv ShirleyTrantham,RN, UtilizationManagementv JoshWalbert, DPT,PM&RSv AuburnWigginton,PharmD

MOVING ON – WHAT’S UP NEXT?TotalhiparthroscopyprotocolsExpandERAStoallsurgicalservices.Integrativetherapies:Expansionofhealingtouch,addition ofvirtualreality,otherCIHImplementminimalfasting

MULTIMODAL ANALGESIA MEDICATION*PROTOCOL DEVELOPEDPREOPERATIVEMEDICATIONS:Gabapentin600mgsPO(onadmissiontodaysurgery)INTRAOPERATIVEMEDICATIONS:IVTylenol1000mgMagnesium30mg/kg(2-3gms)Ketorolac15-30mgs(ifappropriate)Ketamine0.5mgs/kgDexmedetomidine 0.2-0.7mcg/kg/hrZofran4mgLOCALANESTHESIAPERSURGEON - Generallylongeractingagentspreferred(eg.Bupivacaine)

BACKGROUNDvEnhancedRecoveryAfterSurgeryPathways(ERAS)haveemergedasoneofthebeststrategiestoimprovethevalueandqualityofSurgicalCareandhavebeenincreasinglyadoptedforabroadrangeofSurgicalprocedures.

vMultimodal analgesia,incorporatingnonopioid techniques isanintegralpartofthesepathways.Lessemphasis onopioid analgesia.Moreemphasis onregionalanesthesia,non-opioid medications, andothernon-medicinal therapies.

UpcomingEventsCalendarPreviewMay28th SenatorTillis –HuntersvilleVeteransParkDedication

Location:Huntersville,NC Time:10:30– 12:30p

June4th NCVeteransAdvisoryCommittee(VAC)MeetingLocation: V6HQDurham,NC Time: 11a– 1p

June5th VAVeteransAdvisoryCommittee(VAC)MeetingLocation: Richmond,VA Time: 11a– 1p

ActingSecretaryVeteransAffairs – DurhamVAMedicalCenter

June6th VAVeteransAdvisoryCommittee(VAC)MeetingLocation: Salem,VA Time: 11a– 1pActingSecretaryVeteransAffairs –Medical,Biomedical&Biodefense:SupporttotheWarfighterSymposium Location: ChapelHill,NC

June21st ActingSecretaryVeteransAffairs - VARegionalOutreachEventforFaith-based,Nonprofit,Community/NeighborhoodLeadersandOrganizationsLocation:GoodwillIndustries– Winston-Salem,NCTime: 8a– 4:30p