Improving the Quality of Care for Acute Pain Management in Recovery Room at the Georgetown Public Hospital Corporation

Objectives:To observe the method of pain assessment and pain management intervention performed by nurses in the PACU.Methodsand Design:A QI prospective observational study was conducted to observe nurse’s pain assessment and management of thirty (30) patients from the time of PACU admission to discharge. The sample size was determined using the sealed envelope power calculator.Data Collection Included:patients demographics, the method and frequency of pain assessments as well as modalities of the pain intervention and the type and average dose of pain medications administered by PACU nurses. Data analysis was done using Microsoft excel. Results:No validated pain assessment tool was used in the PACU. The majority of patients 67%, n=20) had no pain assessments or pain interventions. When performed, the frequency of pain assessments recorded were low, 70% of patients had 1-2 assessments. The principal pain management intervention was pharmacological with the use of opioids, accounting for 96%.Conclusion:Post-operative pain management in the PACU at GPHC does not meet accepted standards of care. More frequent nursing pain assessment using a validated pain assessmenttool is required. Monotherapy with the opioid was the main pain intervention for pain management. Recommendations:Effective pain management begins with the appropriate pain assessment; therefore pain management education programs for health care professionals are essential. Also, the implementation of a standardized pain assessment tool, a standardized post anesthetic order sheet with a multimodal approach to pain management and restructuring the post-anesthetic record to allow for documentation of pain assessment will greatly improve pain management in the PACU

PAIN OUT: red mexicana para la optimización del dolor postoperatorio / PAIN OUT: Mexican network for the optimization of postoperative pain

Resumen: PAIN OUT es un sistema de gestión en calidad que consiste en un registro internacional (http://.www.pain-out.eu), y tiene la finalidad de realizar auditorías internas que permiten la evaluación y la optimización del tratamiento de pacientes con dolor postoperatorio. En 2016, se inició un proyecto internacional, donde 10 hospitales de la Ciudad de México participaron para mejorar la calidad en la atención del dolor postoperatorio, los cuales fueron coordinados por la Universidad de Jena, Alemania y el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (para más detalles visite http://www.painoutmexico.com).

Abstract: PAIN OUT is a quality management system that consists of an international register (http://.www.pain-out.eu), which aims to perform internal audits that allow the evaluation and optimization of the treatment of patients with postoperative pain. In 2016 an international project was initiated where 10 hospitals in Mexico City participated to improve the quality of postoperative pain care, coordinated by the University of Jena, Germany and the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (for more details visit http://www.painoutmexico.com).

Designing the ideal perioperative pain management plan starts with multimodal analgesia / 대한마취과학회지

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient. Elements of this protocol may include opioids, non-opioid systemic analgesics like acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, and local anesthetics administered by infiltration, regional block, or the intravenous route. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients’ perioperative pain management.