[The Perioperative Management of Pain in Patients Who Are Addicted to Heroin].

Heroin addicts admitted to the hospital for surgery should be treated as high-risk patients because these patients face a significantly higher risk of experiencing severe drug withdrawal symptoms and of pain management complications during hospitalization. The lack of proper pain management often suffered by heroin addicts during hospitalization has been attributed to care providers' insufficient knowledge regarding opioid medications and their addicting effects as well as fears that opioid medications may cause addiction symptoms to reemerge. The objective of this article is to illustrate the pain management process across the entire hospitalization period for heroin-addicted patients undergoing surgical procedures. This process includes management of the heroin-related physical and psychological reactions from surgery, of the mechanism of pain induced specifically from surgery, and of the heroin addiction during the surgical procedure and subsequent clinical management and nursing care. It is hoped that this article assists healthcare providers to better understand the need for the proper pain management and care of heroin-addicted surgical patients over the entire period of hospitalization and thus the enhancement of the overall quality and safety of patient care management procedures.

[A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

BACKGROUND & PROBLEMS: We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. PURPOSE: We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). RESOLUTIONS: We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. RESULTS: After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. CONCLUSIONS: The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.