Conflict of Interest. Background. Objectives. Adverse Events 10/20/2015
|
|
- Debra Summers
- 6 years ago
- Views:
Transcription
1 Utilizing a Structured Pain Management Approach in Total Hip and Total Knee Arthroplasty Jennifer Watson, Medication Safety Pharmacist Gina Anderson-Malum, Total Joint Specialist, Bone & Joint Center Conflict of Interest We hereby certify that, to the best of our knowledge, no aspect of our current personal or professional situation ti might reasonably be expected to affect significantly our views on the subject on which we are presenting. Objectives. Differentiate the assigned pain protocol for the opioid naïve or opioid tolerant patient 2. Design a pain management plan to include adjunct medications Background Why? Why? Why? Why? Why? Adverse events-patient safety Educational conferenes Decrease opioid id usage Structured approach Patient Satisfaction Culture of pain management Adverse Events Naloxone Administered Flumazenil Administered Both reversal agents administered 22 (prior to implementation of RL Solutions) (through June)
2 Patient Scenario 69 y/o, right total knee IV in OR 4mcg Fentanyl in PACU mg Hydromorphone PACU IV x2 on unit 3mg IV Morphine in 24 hrs on unit st 4 hrs=6mg. 4mg Oxycontin Vistaril mg Norco -mg tabs Opioid Naïve vs. Tolerant: What does that really mean? Definitions Opioid Tolerant: Patient who has been taking the following for longer than week: 6mg oral Morphine/day 2mcg transdermal Fentanyl/hour 3mg oral Oxycodone/day 8mg oral Hydromorphone/day 2mg oral Oxymorphone/day Opioid Naïve: any patient not taking the above amounts of medications. Perspective Percocet /32mg -2tabs PO q6h prn = 8 tabs per day = 4mg of PO Oxycodone, 2mg of IV Morphine, 3mg of IV Hydromorphone or 2mcg of IV Fentanyl Norco /32mg -2 tabs PO q6h prn = 8 tabs per day = 4mg of PO Morphine, 3mg of IV Morphine, 2mg of IV Hydromorphone or 3mcg of IV Fentanyl Fentanyl 2mcg = 2.mg of IV Morphine or.38mg of Hydromorphone Hydromorphone mg = 6.7mg of IV Morphine or 7mcg of Fentanyl Pharmacokinetics IV medications: Fentanyl Onset: almost immediate Peak: minutes Half life: 2-4 hours Pharmacokinetics IV medications: Hydromorphone Morphine Onset: minutes Onset: - minutes Peak: -2 minutes Peak: -6 minutes Half life: 2-4 hours Half life: 2-4 hours 2
3 Oral Medications: Hydrocodone/acetaminophen /32mg Onset: 4-9 minutes Peak:.3 hours Half life: 3.8 hours Oxycodone/acetaminophen /32mg Onset: 4-9 minutes Peak:. hours Half life: 3.9 hours Pain Adjuvants Tylenol (acetaminophen) Mild to moderate pain dosing: 6-3mg po q4-6hrs prn; max of 4mg/24hrs Caution in patients with hepatic compromise/failure Advil (ibuprofen) Pain/anti-inflammatory dosing: 6-8mg po q6h prn; max of 24mg/24hrs Caution in patients with renal failure Toradol (ketorolac) Pain/anti-inflammatory dosing: IV: -3mg IV q6hrs prn; max of 6mg/24hrs PO: mg po q6h prn; max of 4mg/24 hrs Max of days of therapy for IV and PO Caution in patients with renal failure Implementation Barriers and Challenges Stakeholders Input other facilities Technical fixes Adaptive Changes Culture Education-Nursing AND Providers Order Set Build Implementation Reinforcement LEARNING TO FAIL Continuum of Care Education The How does this affect me? CSC pre-op medications, orders OR intra-op dose-iv, pain meds PACU IV Dilaudid Bone & Joint, culture PT/OT need of pain meds vs. anticipation 3
4 Non-Rx Pain Management Data Collection Ice Position Elevation Mobility dangle get in chair Exercise walk in hall Aromatherapy Healing touch Shoulder massage Animal therapy Volunteer visitor Diversion ipad, TV, reading, music, cards Others??? Adverse events Opioid totals Patient satisfaction Process analysis Chart review # of Mo orphine Doses Bone & Joint: Elective Knee, Opiod & Pain Management Pre Implementation Post Implementation Avg. # Morphine Doses *42.6% decrease in opioid use for patients with elective knee after implementation of protocol % Patient Reported Pain Hours to First Dose Perc cent 8% 6% 4% 2% Tolerable Not Tolerable ours Ho % Post Op Day IV w/ Tiered Tiered w/o IV.2 First 24 hours: IV Opioid Usage 3 First 24 hours: Oral Opioid Usage Dosag ge (mg) IV w/ Tiered..6 Tiered w/o IV Dosa age (mg) 2 2 IV w/ Tiered 24 7 Tiered w/o IV 4
5 Feedback Larger Impact Providers Patients Staff Face to face Survey Monkey Focus Groups Hospital wide efforts Acute Pain Management Order Set Surgical and Medical Start with smaller population to trial Back surgery Pediatrics-waiting Summary Key Points: Review current pain management practice Consider structured approach; opiate naïve or tolerant Be flexible to change Feedback, feedback, feedback Educate patient and families Reinforce behavior Address pain management culture References Food and Drug Administration (24). Definition of opioid naïve and opioid tolerant. Retrieved November 2, 24 from Governale, L. (2, July 22). Outpatient Prescription Opioid Utilization in the U.S., Years Retrieved from Kang, H., Ha, Y., Kim, J., Woo, Y., Lee, J., & Jang, E. (23). Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study. Journal Of Bone And Joint Surgery. American Volume, 9(4), Lachiewicz, P. (23). The role of intravenous acetaminophen in multimodal pain protocols for perioperative p orthopedic patients. Orthopedics, 36(2), -9. doi:.3928/ Munir, M. A., Enany, N., & Zhang, J. (27). Nonopioid analgesics. Anesthesiology Clinics, 2(4), 76. Micromedex (22-24), Truven Analytics Parvizi, J., & Bloomfield, M. (23). Multimodal pain management in orthopedics: implications for joint arthroplasty surgery. Orthopedics, 36(2), 7-4. doi:.3928/ (Practice Guidelines, 22). Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology, 6(2), [242 references] Retrieved from Tsang, K., Page, J., & Mackenney, P. (23). Can intravenous paracetamol reduce opioid use in preoperative hip fracture patients?. Orthopedics, 36(2), doi:.3928/
Acute Pain Management in the Hospital Setting. Alexandra Phan, PharmD PGY-1 Pharmacy Practice Resident Medical Center Hospital Odessa, TX
Acute Pain Management in the Hospital Setting Alexandra Phan, PharmD PGY-1 Pharmacy Practice Resident Medical Center Hospital Odessa, TX 2 What is Pain? An unpleasant sensory and emotional experience associated
More informationPAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
NON-OPIOID SHORT-ACTING LONG-ACTING **** O PAIN TREATMENT TABLES Analgesics NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose Tramadol 50 mg Ultram Every 4 hours 1-2 tabs,
More informationNATL. II. Health Net Approved Indications and Usage Guidelines: Diagnosis of cancer AND. Member is on fentanyl transdermal patches AND
Coverage of drugs is first determined by the member s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document I. FDA Approved Indications: The management of breakthrough
More informationFighting the Good Fight: How to Convert Opioids Just Right!
Fighting the Good Fight: How to Convert Opioids Just Right! Tanya J. Uritsky, PharmD, BCPS, CPE Clinical Pharmacy Specialist - Pain Medication Stewardship Hospital of the University of Pennsylvania - Philadelphia,
More informationPharmacologic Considerations for Managing Sickle Cell Pain Claire Saadeh, PharmD, BCOP May 5, 2015
Pharmacologic Considerations for Managing Sickle Cell Pain Claire Saadeh, PharmD, BCOP May 5, 2015 Table 1: Physiologic changes that occur during sickle cell pain crisis 1-3 Phase Description / Complications
More informationOxycodone dose paediatric mg kg
P ford residence southampton, ny Oxycodone dose paediatric mg kg Principal author(s) Thierry Lacaze, Pat O Flaherty; Canadian Paediatric Society, Fetus and Newborn Committee. Abstract. The incidence of
More information10 mg hydrocodone equals how much oxycodone
Cari untuk: Cari Cari 10 mg hydrocodone equals how much oxycodone Posts about dilaudid 8 vs oxycodone 30 written by buyprescriptionmedication. Can you help me with the conversion of Oxycodone IR (5mg tab)
More informationPain and the MGH Promise
Pain is an unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in terms of such damage Our promise to patients we will always: Work as a team to evaluate,
More informationDigital RIC. Rhode Island College. Linda M. Green Rhode Island College
Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Research and Major Papers Overview Master's Theses, Dissertations, Graduate Research and Major Papers 1-1-2013 The Relationship
More informationPAIN MANAGEMENT PGY-1. Aaron D. Storms, MD Carin van Zyl, MD Adult and Pediatric Palliative Care, LAC+USC Keck School of Medicine of USC
PAIN MANAGEMENT PGY-1 Aaron D. Storms, MD Carin van Zyl, MD Adult and Pediatric Palliative Care, LAC+USC Keck School of Medicine of USC Perception Matters A builder aged 29 came to the accident and emergency
More information15mg oxycodone is equivalent to how much morphine
15mg oxycodone is equivalent to how much morphine The Borg System is 100 % 15mg oxycodone is equivalent to how much morphine nursing home activity director cover letter 15 mg oxycodone equal to how much
More informationPEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders
- Phase: Pediatric Spine Surgery General Orders PHYSICIAN S Diagnosis Weight Allergies Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert
More informationmorphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)
More informationOpioid Capture in the AHSQC Can we reduce use by measuring it? Michael Reinhorn MD, MBA, FACS Dept of Surgery, Newton Wellesley Hospital
Opioid Capture in the AHSQC Can we reduce use by measuring it? Michael Reinhorn MD, MBA, FACS Dept of Surgery, Newton Wellesley Hospital Disclosure Davol/Bard Consultant Medtronic Physician Advisory Honorarium
More informationLumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.
Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical
More informationPeri operative pain control. Disclosure. Objectives 9/1/2011. No current conflicts of interest
Peri operative pain control Chris Herndon, PharmD, FASHP Southern Illinois University Edwardsville Disclosure No current conflicts of interest Objectives Discuss studies evaluating the transformation of
More informationPOST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS
POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS November 9, 2018 Aimee LaMere, CNP Molly McNaughton, CNP Leslie Weide, MSW, LICSW, ACM Disclosures: Conflict of interest statement: We certify that,
More informationPEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating
More information15 mg morphine 10 mg hydrocodone
Cari untuk: Cari Cari 15 mg morphine 10 mg hydrocodone 3-2-2013 Convert From CALCULATED MORPHINE EQUIVALENT BY RESOURCE: Average ( mg ) Range ( mg ) Standard Deviation of Sample ( mg ) Hydrocodone. I usually
More informationOrthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
More informationAnalgesics: Management of Pain In the Elderly Handout Package
Analgesics: Management of Pain In the Elderly Handout Package Analgesics: Management of Pain in the Elderly Each patient or resident and their pain problem is unique. A complete assessment should be performed
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Transmucosal Immediate Release Fentanyl Products Reference Number: CP.CPA.211 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder
More informationPage 1 of 8. 7 SICKNESS AND HEALTH 7.1. chronic diseases and quality of life
Page 1 of 8 7 SICKNESS AND HEALTH 7.1. chronic diseases and quality of life Illnesses are classified as either acute or chronic. An acute illness lasts for a short period of time and may go away without
More informationUpdate on Pain: Collaborative Care for the Complex Patient
Update on Pain: Collaborative Care for the Complex Patient Nirmala R. Abraham, MD Medical Director Sycamore Pain Management Center Kettering Health Network Objectives Standardized approach to patient care
More information(30689) PROT Pain PCA Adult Patient Controlled Analgesia
Diagnosis Allergies Nursing Assess and Document PCA: 1. Assess and document pain rating, sedation level and respiratory rate every 2 hours; assess and document pain rating, sedation level and respiratory
More informationThe Role of the Pharmacist in Postoperative Pain Management: Strategies to Help Combat the Epidemic
The Role of the Pharmacist in Postoperative Pain Management: Strategies to Help Combat the Epidemic Presented By: Cheryl Genord, R.Ph. B.S.Pharm Clinical Pharmacy Specialist Learning Objectives Describe
More informationOpioid Conversions Mixture of Science and Art
Opioid Conversions Mixture of Science and Art Matthew J. Pingree, MD Assistant Professor Division of Pain Medicine Physical Medicine and Rehabilitation and Anesthesiology Mayo Clinic, Rochester Pingree.Matthew@Mayo.edu
More informationOverview of Essentials of Pain Management. Updated 11/2016
0 Overview of Essentials of Pain Management Updated 11/2016 1 Overview of Essentials of Pain Management 1. Assess pain intensity on a 0 10 scale in which 0 = no pain at all and 10 = the worst pain imaginable.
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationPo dilaudid versus iv dilaudid
Po dilaudid versus iv dilaudid Search IM/IV/SC 120 mg ratios of morphine to methadone in patients with neuropathic pain versus non-neuropathic an equianalgesic ratio for PO. Dilaudid official prescribing
More informationGUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS
GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: North Bristol 0117 4146392 UH Bristol 0117
More informationA Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse
A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse INVESTIGATIVE TEAM: STEERING COMMITTEE FOR THE TUFTS HEALTH CARE INSTITUTE ON OPIOID RISK MANAGEMENT
More informationEffective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1
Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1 Fast onset of pain relief with 7% reduction in visual analog scale (VAS) scores
More information30 mg codeine vs 5 mg hydrocodone
30 mg codeine vs 5 mg hydrocodone Gogamz Menu question: if 1 mg of suboxone is equal to 20-30 mgs of hydrocodone would that be the same for oxycontin would 1 mg of sub be equal to 20-30 mgs oxy then? Thanks.
More informationSTARTER PACK: Webinar #1 ADE4 - OPIOIDS
STARTER PACK: Webinar #1 ADE4 - OPIOIDS Welcome to the Starter Pack Webinar #1 Why this is important Establishing a Team Best practices Understanding the Measures Completing a gap analysis First Steps
More informationBrief Pain Surveys. Developed by: Betty R. Ferrell, PhD, FAAN and Margo McCaffery RN, MSN, FAAN
Brief Pain Surveys Pain Assessment/Behavior Survey Pain/Gender Survey Brief Cancer Pain Information Survey Pain Addiction Survey Brief Pharmacology Survey Test Questions Developed by: Betty R. Ferrell,
More informationAPPENDIX E: HEALTHCARE PRACTITIONER- REPORTED REDUCTION OF PAIN MEDICATION
Contents Appendix E: Healthcare Practitioner-Reported Reduction of Pain Medication... E-1 Appendix E: Healthcare Practitioner- Reported Reduction of Pain Medication Note: Word choice and spellings have
More informationdisease or in clients who consume alcohol on a regular basis. bilirubin
NON-OPIOID Acetaminophen(Tylenol) Therapeutic class: Analgesic, antipyretic Aspirin (ASA, Acetylsalicylic Acid) Analgesic, NSAID, antipyretic Non-Opioid Analgesics COMMON USES WHAT I NEED TO KNOW AS A
More informationAnesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty
Anesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty Scott T. Ball, MD Chief, Adult Joint Reconstruction Department of Orthopaedic Surgery University of California, San Diego Disclosures
More informationCONCERNED ABOUT TAKING OPIOIDS AFTER SURGERY?
CONCERNED ABOUT TAKING OPIOIDS AFTER SURGERY? ASK YOUR DOCTOR ABOUT EXPAREL FOR LONG-LASTING, NON-OPIOID PAIN RELIEF. VISIT EXPAREL.com/patient FOR MORE INFORMATION. YOU HAVE A SAY IN HOW YOUR PAIN IS
More informationPAIN PODCAST SHOW NOTES:
PAIN PODCAST SHOW NOTES: Dallas Holladay, DO Ultrasound Fellow Cook County Hospital Rush University Medical Center Jonathan D. Alterie, DO PGY-2, Emergency Medicine Midwestern University An overview of
More informationPALLIATIVE TREATMENT BY DR. KHRONGKAMOL SIHABAN MEDICAL ONCOLOGIST
PALLIATIVE TREATMENT BY DR. KHRONGKAMOL SIHABAN MEDICAL ONCOLOGIST TREATMENT IN ONCOLOGY Main treatment : surgery Neoadjuvant treatment : RT, CMT Adjuvant treatment : Tx micrometastatic disease -CMT,Targeted
More informationEquianalgesic Dosing: Making Opioid Interchange Easier. Joseph Bubalo PharmD, BCPS, BCOP Oncology Clinical Pharmacist Assistant Professor Of Medicine
Equianalgesic Dosing: Making Opioid Interchange Easier Joseph Bubalo PharmD, BCPS, BCOP Oncology Clinical Pharmacist Assistant Professor Of Medicine 1 Why Change Opioids? Side Effects Insufficient Pain
More informationWhat a Pain! A Review of Post-operative Pain Management. Ashley W. Sturm, PharmD, BCPS. Pharmacy Grand Rounds March 21 st, MFMER slide-1
What a Pain! A Review of Post-operative Pain Management Ashley W. Sturm, PharmD, BCPS Pharmacy Grand Rounds March 21 st, 2017 2016 MFMER slide-1 Objectives Review multi-modal approach for pain control
More information(Page 1 of 5) Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental Knee Left Total Hip Revision Total Shoulder
(Page 1 of 5) Allergies/Sensitivities/Reactions: Height: Inches cm Weight: Kg Pounds = Automatic = Physician s option, Check off to Order Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental
More informationOPIOID REDUCTION INITIATIVE FOR SURGICAL PATIENTS AT KAISER PERMANENTE
OPIOID REDUCTION INITIATIVE FOR SURGICAL PATIENTS AT KAISER PERMANENTE DAVID PARSONS, MD NORTHWEST PERMANENTE PC MID-WILLAMETTE VALLEY PAIN SUMMIT SEPTEMBER 22, 2017 HOW BIG IS THIS PROBLEM? 2001 JCAHO:
More informationInitials * Page 1 of 6. (place patient label here) Patient Name: Diagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: Orthopedic Upper Ext Post Op Version 3 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
More informationAmber D. Hartman, PharmD Specialty Practice Pharmacist James Cancer Center & Solove Research Institute Ohio State University Medical Center
Pharmacologic Management of Pain Amber D. Hartman, PharmD Specialty Practice Pharmacist James Cancer Center & Solove Research Institute Ohio State University Medical Center Objectives Identify types of
More informationBaptist Health Lexington. ERAS Protocols
Baptist Health Lexington ERAS Protocols Enhanced Recovery After Surgery BHLex Colorectal ERAS Protocol Preoperative Patient/Family Education: PAT and office, ERAS brochure & educational flyer/checklist
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Transmucosal Immediate Release Fentanyl Products Reference Number: CP.HNMC.211 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important
More informationWHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
More informationLimitations of use: Subsys may be dispensed only to patients enrolled in the TIRF REMS Access program (1).
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.21 Subject: Subsys Page: 1 of 5 Last Review Date March 17, 2017 Subsys Description Subsys (fentanyl
More informationTHE EFFECT OF AN ENHANCED RECOVERY PROTOCOL IN BARIATRIC SURGERY POSTOPERATIVE PAIN
THE EFFECT OF AN ENHANCED RECOVERY PROTOCOL IN BARIATRIC SURGERY POSTOPERATIVE PAIN BRITTANI SEAGREN, DNP, APRN-NP, FNP-C, RN-BC CONFLICT OF INTEREST DISCLOSURE THE AUTHOR OF THIS PRESENTATION (BRITTANI
More informationPain Management Management in Hepatic Hepatic and and Renal Dysfunction
Pain Management in Hepatic and Renal Dysfunction Review the pharmacologic basis for medications used in pain management Identify pain medications which hshould ldbe avoided in patients with hepatic dysfunction
More informationQUANTITY LIMIT AND POST LIMIT PRIOR AUTHORIZATION CRITERIA
DRUG CLASS QUANTITY LIMIT AND POST LIMIT PRIOR AUTHORIZATION CRITERIA EXTENDED-RELEASE OPIOID ANALGESICS BRAND NAME (generic) ARYMO ER (morphine sulfate extended-release tablets) AVINZA (morphine extended-release
More informationReview of Pain Management with Clinical and Regulatory Updates
Review of Pain Management with Clinical and Regulatory Updates Palliative Care Collaborative: 8 th Annual Regional Conference October 10, 2014 Michael Stellini, M.D.,M.S. Medical Director, Hospice and
More informationPain Management Protocol in Adolescent Idiopathic Spinal Fusion Reduces Length of Stay and Complications
Pain Management Protocol in Adolescent Idiopathic Spinal Fusion Reduces Length of Stay and Complications Abstract Authors: Karen Martin, RHIT, CPHQ - Surgical Clinical Reviewer - Quality Management Analyst,
More informationManaging Pain in Individuals with Serious Illness and Comorbid Substance Use Disorder
Managing Pain in Individuals with Serious Illness and Comorbid Substance Use Disorder Presented by: Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN on December 1, 2016 Webcast Questions and Answers (Answers
More informationPalliative and Hospice Care of the Terminally Ill Introduction
Palliative and Hospice Care of the Terminally Ill Introduction There has been an increase in life expectancy for men and women of all races to 77.6 years Leading causes of death in older patients are chronic
More informationDevelopment of a Comprehensive Opioid Management Program in Rural Orthopaedics
Development of a Comprehensive Opioid Management Program in Rural Orthopaedics Joshua Horowitz MD and Adam English CNP Cuyuna Regional Medical Center Crosby, MN Discussion Discuss current opioid statistics
More informationDemystifying Opioid Conversion Calculations
Demystifying Opioid Conversion Calculations Stephanie Cheng, PharmD, MPH, BCGP Clinical Pharmacist Hospice Pharmacy Solutions November 28, 2018 Learning Objectives After this presentation, you should be
More informationUCSF Pediatric Hospital Medicine Boot Camp Pain Session 6/21/14. Cynthia Kim and Stephen Wilson
UCSF Pediatric Hospital Medicine Boot Camp Pain Session 6/21/14 Cynthia Kim and Stephen Wilson Rules Buzz first and player answers If answer correct, then the player asks teammates if they want to keep
More informationOxycontin conversion to ms contin
Oxycontin conversion to ms contin The Borg System is 100 % Oxycontin conversion to ms contin Ms contin to morphine conversion MS Contin is. The patient s current dose of 240 mg per day of oral oxycodone
More informationEvaluating the Effectiveness of Current Orthopaedic Pain Management Strategies
Evaluating the Effectiveness of Current Orthopaedic Pain Management Strategies TOPICS: Impact of Health Care Changes Current Strategies in Surgical Pain Management Implementing and Evaluating Pain Management
More informationFENTANYL CITRATE TRANSMUCOSAL UTILIZATION MANAGEMENT CRITERIA
FENTANYL CITRATE TRANSMUCOSAL UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: BRAND (generic) NAMES: HICL = H3AT Fentanyl citrate transmucosal Actiq (fentanyl citrate) lozenge on a handle 200, 400, 600, 800,
More informationHow long to wait between taking oxycodone and gabapentin
How long to wait between taking oxycodone and gabapentin Search GO How long to wait between taking oxycodone and gabapentin Learn about drug interactions between gabapentin oral and hydrocodone- acetaminophen.
More informationAgenda. Case Discussions. Managing Acute & Chronic Pain (requiring opioid analgesics) in Patients on MAT. Daniel Alford, MD Disclosures
Managing Acute & Chronic Pain (requiring opioid analgesics) in Patients on MAT Case Discussions August 26, 2014 PCSS MAT Webinar Sponsored by the American Psychiatric Association Daniel P. Alford, MD,
More informationIllinois EMS for Children 2005 Survey of Pediatric Pain Management in the Emergency Department
Illinois EMS for Children 2005 Survey of Pediatric Pain Management in the Emergency Department 1. How does your emergency department define the pediatric population? 0 0 through 12 years old 0 0 through
More informationWORRIED ABOUT PAIN AFTER ORAL SURGERY?
WORRIED ABOUT PAIN AFTER ORAL SURGERY? OPIOIDS ARE NOT THE ONLY WAY TO MANAGE PAIN Ask your doctor about opioid-free EXPAREL EXPAREL is indicated for single-dose infiltration in adults to produce postsurgical
More information4/3/2018. Management of Acute Pain Crises. Five Mistakes I ve made and why you shouldn t
Management of Acute Pain Crises Maggie O Connor, M.D. Retired Palliative Care Physician Hope is not the conviction that something will turn out well, but the certainty that something makes sense, regardless
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More information3/27/2019. Reducing Inpatient Opioid Consumption. Conflict of Interest. Educational Objectives
Reducing Inpatient Opioid Consumption Creating a Therapeutic Foundation with Breakthrough Analgesia Based on Patient Function Chad Dieterichs, MD Peggy Lutz, FNP-BC, RN-BC March 27, 2019 1 Conflict of
More informationCHAMP: Bedside Teaching TREATING PAIN. Stacie Levine MD. What is the approach to treating pain in the aging adult patient?
CHAMP: Bedside Teaching TREATING PAIN Stacie Levine MD Teaching Trigger: An older adult patient is identified as having pain. Clinical Question: What is the approach to treating pain in the aging adult
More informationPrior Authorization Guideline
Guideline GL-35952 Opioid Quantity Limit Overrides Formulary OptumRx Formulary Note: Approval Date 7/10/2017 Revision Date 7/10/2017 Technician Note: P&T Approval Date: 2/16/2010; P&T Revision Date: 7/12/2011
More informationMILD PAIN Pain Scale Ratin g 1/5 ( 0-5 Scale ) or 1-3/10 ( 0-10 Scale)
MILD PAIN Pain Scale Ratin g 1/5 ( 0-5 Scale ) or 1-3/10 ( 0-10 Scale) Complete Pain Assessment. Establish probable cause of pain when possible. Determine goal for pain relief with patient and acceptable
More informationOpioid Conversion Guidelines
Opioid Conversion Guidelines March 2015 Gippsland Region Palliative Care Consortium Clinical Practice Group Title Keywords Ratified Opioid, Conversion, Drug, Therapy, Palliative, Guideline, Palliative,
More informationHip Hemiarthroplasty Post Op Version 2 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Hip Hemiarthroplasty Post Op Version 2 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro PCU ICU General
More informationPain Management. University of Illinois at Chicago College of Nursing
Pain Management University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this module, participants will be better able to: 1. Define pain management 2. Explore various
More informationWhat to do when you are called to see a patient with... PAIN. Susan Merel, MD Division of General Internal Medicine July 2018
What to do when you are called to see a patient with... PAIN Susan Merel, MD Division of General Internal Medicine July 2018 Disclosures Susan Merel has no relationships with any entity producing, marketing,
More informationA PATIENT GUIDE FOR MANAGING PAIN
A PATIENT GUIDE FOR MANAGING PAIN PAIN MANAGEMENT Knowing the Facts Pain can be controlled. Pain is common after surgery and with many types of illnesses. Most patients with acute and chronic pain can
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form***
More informationMANAGING PAIN IN THE PACU
MANAGING PAIN IN THE PACU Capt David Bradley, RN, BSN,CNOR Uniformed Services University OBJECTIVES Describe the importance of pain management in regards to the organization, family and patient Describe
More informationE-Learning Module N: Pharmacological Review
E-Learning Module N: Pharmacological Review This Module requires the learner to have read Chapter 13 of the Fundamentals Program Guide and the other required readings associated with the topic. Revised:
More informationEducation Program for Prescribers and Pharmacists
Transmucosal Immediate Release Fentanyl (TIRF) Products Risk Evaluation and Mitigation Strategy (REMS) Education Program for Prescribers and Pharmacists Products Covered Under this Program Abstral (fentanyl)
More informationNew Hampshire Healthy Families CLINICAL POLICY
New Hampshire Healthy Families CLINICAL POLICY DEPARTMENT: Pharmacy DOCUMENT NAME: Opioid Analgesics PAGE: 1 o f 6 REFERENCE NUMBER: NH.PPA.13 EFFECTIVE DATE: 6/1/2016 REPLACES DOCUMENT: N/A RETIRED: REVIEWED:
More informationMorphine er to oxycontin conversion
Morphine er to oxycontin conversion The Borg System is 100 % Morphine er to oxycontin conversion 17-4-2011 Conversion dose from Oxycontin 40mg 3x a day to morphine sulfate 15 mg?. Oxycontin vs morphine
More informationTreating Pain in Pediatrics: Safety First. Nicole Ralston, RN Jamie Sperduto, RN, BSN
Treating Pain in Pediatrics: Safety First Nicole Ralston, RN Jamie Sperduto, RN, BSN Background Information Due to the current opioid crisis that most states are experiencing, it is necessary to institute
More informationDemerol 50 mg vs hydrocodone
Demerol 50 mg vs hydrocodone The Borg System is 100 % Demerol 50 mg vs hydrocodone 7-2-2016 What's the difference between the effects of Demerol and. Oxycodone 15-20 mg (orally) Vicodin (hydrocodone).
More informationUCSF: 150 years in the making
Securing Hospital Approval for Ketamine use on the Wards: Challenges, Outcomes and Lessons Learned Acknowledgements Mark Schumacher Ph.D.,M.D. Professor and Chief, Division of Pain Medicine Dept. of Anesthesia
More informationPain Management in the Elderly. Martha Watson, MS, APRN, GCNS Christie Bowser, RN-BC, RN
Pain Management in the Elderly Martha Watson, MS, APRN, GCNS Christie Bowser, RN-BC, RN Objectives So How Much Do You Really Know? www.geriatricpain.org Geriatric Pain Knowledge Assessment The Geriatric
More informationOxycodone vs hydrocodone acetaminophen 5 325
Search Oxycodone vs hydrocodone acetaminophen 5 325 30-6-2010 Oxycodone vs Hydrocodone. Oxycodone and hydrocodone are two highly debated drugs often prescribed to relieve. 17-2-2018 What is the exact difference
More informationBariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
More informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
More informationMusic medicine: A post-operative adjunct
Music medicine: A post-operative adjunct Anesthesia Research Rounds January 8 th, 2013 Aaron Lau CC3 Marko Erak CC3 Outline Overview of current literature Identified research opportunity Proposed pilot
More informationDose equivalent of fentanyl patch to oxycontin
Dose equivalent of fentanyl patch to oxycontin 10-3-2018 Detailed dosage guidelines and administration information for OxyContin (oxycodone hydrochloride). Includes dose adjustments, warnings and precautions.
More informationPain and Ways to Manage It
Pain and Ways to Manage It FM.850.M311.PHC (R.Jul-15) 1 Contents This page intentionally left blank. What the words mean............................. 2 Why is it important to manage your pain?............
More informationPain and patient experience: A business partnership Managing patients pain is no longer just a clinical goal it s a business necessity.
Performance improvement Pain and patient experience: A business partnership Managing patients pain is no longer just a clinical goal it s a business necessity. The Centers for Medicare and Medicaid Services
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationORTHO TOTAL KNEE REPLACEMENT POST-OP PLAN - Phase: PACU Ortho Phase
- Phase: PACU Ortho Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate
More informationOpioid Pearls and Acute Pain Management
Opioid Pearls and Acute Pain Management Jeanie Youngwerth, MD University of Colorado Denver Assistant Professor of Medicine, Hospitalist Associate Director, Colorado Palliative Medicine Fellowship Program
More information