ADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management. March 21, 2013
|
|
- Jody Carson
- 6 years ago
- Views:
Transcription
1 ADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management March 21, 2013
2 Agenda, March 21, 2013 Welcome Collaborative education overview Post-operative Pain Management: Challenges and New Directions T.J. Gan, M.D., MHS, F.R.C.A FFARCS(I) Professor and Vice Chair for Clinical Research, Department of Anesthesiology, Duke University Medical Center Q & A Monthly Progress Reports Next Steps 2 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
3 Collaborative Objectives Safer post-operative pain management that reduces both ADEs and Harm Address three focus areas: Identification (screening patients for risk)»webinar 1 and 2 Standardization of monitoring post-operative patients on opioids (tools/technology/processes)»webinar 3 and 4 Education and communication (at transitions of care and discharge)»webinar 5 and 6 3 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
4 What do we want to accomplish? Goal: To reduce ADEs and Harm associated with opioids use among surgical inpatients by implementing evidence-based strategies and processes to make pain management safer By the end of 2013, reduce opioid related ADEs and Harm by 40% compared to 2010 For pilot population, by : 100% elective surgery patients screened preoperatively for OSA and opioid tolerance 100% elective surgery patients pain assessed using a standardized tool 100% elective surgery patients discharged to home on an opioid will have documentation of written/verbal discharge instructions to include: the name, purpose, action, side effects, monitoring and what to do if this happens for the opioid discharge medication. 4 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
5 Focus 2: Safe communication and monitoring during the perioperative period A standardized hand-off/transition communication process is in place for all patients receiving opioids, which includes, at minimum: 1) history of snoring, obesity or OSA and 2) drug and dose history for previous shift; Standardization of pain assessment tools for patients on opioids post-operatively house-wide; Continuous oximetry is used in all post-operative patients receiving IV narcotics/ opioids; and, Continuous capnography is used on all post-operative patients receiving supplemental oxygen and receiving IV narcotics/opioids, epidural, or PCA (patient controlled analgesia) 5 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
6 Post-operative Pain Management. Challenges and New Directions T. J. Gan, M.D., MHS, F.R.C.A. FFARCS(I) Professor and Vice Chair for Clinical Research Department of Anesthesiology Duke University Medical Center
7 Incidence and Severity of Postoperative Pain 1. Apfelbaum, Gan et al. Anesth Analg Warfield, et al. Anesthesiology Gan TJ. ASRA 2012 abstract.
8 Readmissions from Same-day Surgeries: Pain Is Most Common Reason (US) Mean charges for patients readmitted due to pain were $1,869 ± $4,553 per visit 38% of patients readmitted for pain had undergone orthopedic procedures
9 Inadequate Acute Pain Management Has Consequences Delayed ambulation1 Increased CV and pulmonary pathophysiology Shortened or missed rehabilitation sessions1 Decreased quality of life2 Increased cost of care3 Potential for progression from acute to chronic pain4 1. Morrison et al. Pain. 2003;103: ; 2. Wu et al. Anesth Analg. 2003;97: ; 3. Coley et al. J Clin Anesth. 2002;14: ; 4. Pluijms et al. Acta Anaesthesiol Scand. 2006;50:
10 Long-Term Consequences of Acute Pain: Potential for Progression to Chronic Pain Woolf. Ann Intern Med. 2004;140:441; Petersen-Felix. Swiss Med Weekly. 2002;132: ; Woolf. Nature.1983;306: ; Woolf et al. Nature. 1992;355:75-8.
11 Acute Postoperative Pain Has Been Associated With Chronic Pain After Common Procedures Incidence of Chronic Post-Surgical Pain US Surgical Volumes (1000s) 1 Amputation 57-62% Breast surgery 27-48% 3,4 479 Thoracotomy 52-61% 5,6 110 Inguinal hernia repair 19-40% 7,8 609 Coronary artery bypass 23-39% Caesarean section 12% Factors correlated with the development of post-surgical chronic pain 1 : 1.Nerve injury 2.Inflammation 3.Intense acute postoperative pain 1. Kehlet et al. Lancet. 2006;367: ; 2. Hanley et al. J Pain. 2007;8:102-10; 3. Carpenter et al. Cancer Prac. 1999;7:66-70; 4. Poleschuk et al. J Pain. 2006;7: ; 5. Katz et al. Clin J Pain. 1996;12:50-55; 6. Perttunen et al. Acta Anaesthesiol Scand. 1999;43: ; 7.Massaron et al. Hernia. 2007;11: ; 8. O Dwyer et al. Br J Surg. 2005;92: ; 9. Steegers et al. J Pain. 2007;8: ; 10. Taillefer et al. J Thorac Cardiovasc Surg. 2006;131: ; 11. Bruce et al. Pain. 2003;104: ; 12. Nikolajsen et al. Acta Anaesthesiol Scand. 2004;48:
12 The Severity of Post-Operative Pain is Associated With Development of Chronic Pain In a long term evaluation of thoracotomy patients (N=149), Those who developed chronic postthoracotomy pain syndrome were: Those who experienced severe acute pain: 67% vs 38% (P = ) Those who experienced a prolonged duration (1month) of severe acute pain (P = 0.02) *Chronic pain assessed 6 months to 3.5 years post-surgery Pluijms et al. Acta Anaesthesiol Scand. 2006;50:
13 Patient s Perspectives on Hospital Pain Management The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first national, standardized, publicly reported survey measuring and comparing patients perceptions of their hospital experiences In two 1-year, nationwide HCAHPS surveys of 3765 reporting hospitals conducted in 2008 and 2009, pain management received an average score of 68 (out of a possible 100), revealing room for improvement in pain management Results of the HCAHPS will soon be one of the measures used to calculate institutional incentive payments
14 HCAHPS in Pain Management : July 2009 June 2010 Hospital Consumer Assessment of Health Plans Survey
15 Opioids Main Strong Analgesic Bind to opioid receptors in spinal cord, brainstem and limbic cortex Good Efficacy: dose dependent pain relief with no ceiling effect Good Safety Profile: No cardiovascular, hepatic or renal effects Multiple agents: Morphine, hydromorphone, fentanyl, sufentanil, oxycodone, oxymorphone Multiple delivery systems: oral, parenteral, transdermal, epidural, spinal
16 Side Effects Postsurgery Up to Two Weeks
17 Opioid Analgesic Monotherapy
18 Respiratory Depression and Cardiac Arrest With Morphine is Often Unpredictable
19 Morphine or Incision Length Correlation With Bowel Function Return? Colectomy patients (40) Primarily left colon and rectal procedures Return of bowel function? Correlation between morphine PCA dose and first bowel sounds (P = 0.001), flatus (P = 0.003), and first bowel movement (shown; P = 0.002) No correlation between incision length and morphine dose PCA = patient-controlled analgesia. Adapted with permission from Cali RL, et al. Dis Colon Rectum. 2000;43:
20 Trade-offs in Pain Management: Patients Have Concerns That May Hinder Treatment Gan et al. Brit J Anaesthesia. 2004;92:681-68
21 Recent Joint Commission Sentinel Event Alert Reinforces the Severity of the Opioid Problem Opioid analgesics rank among the drugs most frequently associated with adverse drug events A number of safety measures, including education and monitoring, may reduce the risks of opioid-related adverse events Key patients warrant multimodal opioid sparing approaches; including non-opioid pain medications Patients at the Highest Risk for Oversedation and Respiratory Depression Sleep apnea or sleep disorder Morbid obesity Snoring Older age No recent opioid use Post-surgery, especially after upper abdominal or thoracic surgery Increased opioid dose requirement Longer time receiving general anesthesia during surgery Concomitant use of other sedating drugs Smoker
22 Outcomes: Cost and Length of Stay (LOS) Regional ADE=adverse drug event. Oderda, Gan et al. J Pain & Palliative Care Pharmacotherapy 2012
23 Effect of Opioid-Related Adverse Events on Outcomes in Selected Surgical Patients
24 What are we trying to achieve? Effective and consistent analgesia Minimal adverse events Patient satisfaction
25 Balancing the imperatives
26 Multimodal or balanced analgesia doses of each analgesic Improved antinociception due to synergistic/ additive effects May severity of side effects of each drug Kehlet H, et al. Anesth Analg 1993;77: Playford RJ, et al. Digestion 1991;49:
27 Monotherapy vs Multimodal Analgesia Give More Opioids! Potent Opioids Weak Opioids Breakthrough Pain Moderate to Severe Pain Mild to Moderate Pain Weak Opioids, Tapentadol Neural Blockade, Ketamine Acetaminophen, NSAIDs, Coxibs, Gabapentanoids,
28 A Multimodal Approach Addresses the Complex Nature of Pain Transmission
29 Anesthesiology Whenever possible, anesthesiologists should employ multimodal pain management therapy. Unless contraindicated, all patients should receive an around-the-clock regimen of NSAIDs, coxibs, or acetaminophen. ASA Task Force on Acute Pain Management. Anesthesiology. 2012;116:248 73
30 Adjunctive Analgesics NSAIDs and COX-2 selective inhibitors (coxibs) Acetaminophen Local anesthetics Ketamine Gabapentin / pregabalin Clonidine / dexmedetomidine Magnesium, neostigmine, adenosine, naloxone Non pharmacological techniques
31 New Analgesics and Novel Delivery Systems New Analgesics Cannabinoids: Dronabinol, Ajulemic acid TRP-V1 receptor agonist: Capsaicin, Resiniferatoxin Anti-nerve growth factor- NGF Antibodies LOX Inhibitors- Powerful anti-inflamatories that have less side effects Novel Delivery System Depobupivacaine Fentanyl iontopheresis Sufentanil Nanotap
32 Enhanced Recovery After Surgery (ERAS) An interdisciplinary multimodal concept to accelerate postoperative convalescence and reduce general morbidity (including POI) by simultaneously applying several interventions What are the appropriate choices in constructing ERAS, multimodal protocols? Mattei P. World J Surg. 2006;30: Person B, Wexner S. Curr Probl Surg. 2006;43:6-65.
33 Miller and Gan et al. Anesthesiology ASA abstract 2011 Reduction in length of stay and complications Traditional ERAS p-value LOS all procedures (days) 9.6 ± 8.4; 7 (5.5-10)* 5.8 ± 3.9; 5 (3-7)* < LOS open (days) 11.8 ± 9.9; 7 (6-14)* 7.1 ± 3.9; 6 ( )* LOS laparoscopic (days) 6.5 ± 3.8; 6 (4.25-7)* 4.9 ± 3.7; 4(3-5.5)* Urinary Tract Infection (UTI) 26.5% 13.4% 0.03 Mean ± SD; Median (IQR)
34 Pain Score and Morphine Consumption Traditional Care vs. ERAS Miller and Gan et al. Anesthesiology Abstract 2011
35 Ketamine in Opioid Dependent Patients Undergoing Spine Surgery Ketamine Placebo P Value % PACU Morphine (mg) 18 ± ± PACU VAS 4.1 ± ± h Morphine (mg) 142 ± ± h Morphine (mg) 203 ± ± VAS 5.4 ± ± week Morphine mg/hr equivalents 0.8 ± ± week VAS 3.1 ± ± Hospital Discharge (min) 4, hour Loftus R, et al. Anesthesiology 2010;113:639-46
36 Conclusions Pain is still poorly managed Acute pain can lead to long-term chronic pain Opioid analgesics, while effective, can result in significant side effects Multimodal analgesic regimen improves both shortand long-term pain management Moving from opioid based to opioid sparing regimen
37 Questions?
38 Q&A T.J. Gan, M.D., MHS, F.R.C.A. FFARC S (I) Professor and Vice Chair for Clinical Research Department of Anesthesiology Duke University Medical Center Leslie Schultz, RN, PhD, CPHQ Clinical Consultant Premier Safety Institute Jeff Vawter, MHA Director, Partnership for Patients Collaborative Education & Delivery Cristina Wilhelm, RN, BSN Manager, QUEST Collaborative Education & Delivery 38 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
39 Thank you for participating in today s Webinar! Questions after today s presentation? Please contact us: Cristina Wilhelm, Manager, QUEST Collaborative Education & Delivery cristina_wilhelm@premierinc.com Jeff Vawter, Director, PFP Collaborative Education & Delivery jeff_vawter@premierinc.com 39 PROPRIETARY & CONFIDENTIAL 2012 PREMIER INC.
STARTER 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 informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
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 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 informationFast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationImproving acute pain care with multimodal analgesia. Sponsored by Mallinckrodt Pharmaceuticals.
Improving acute pain care with multimodal analgesia Discussion topics Section 1 Opioid monotherapy and the state of acute pain management Section 2 Multimodal analgesia for balanced acute pain management
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationManagement of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017
Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationNYSPFP Kickoff. Reducing Adverse Drug Events from Opioids. April 6, 2017
NYSPFP Kickoff Reducing Adverse Drug Events from Opioids April 6, 2017 I have no financial relationships with drug companies, durable medical equipment companies or other for profit entities related to
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 informationResponding to The Joint Commission Alert on Safe Use of Opioids in Hospitals
Responding to The Joint Commission Alert on Safe Use of Opioids in Hospitals Suzanne A Nesbit, PharmD, CPE Clinical Pharmacy Specialist, Pain Management The Johns Hopkins Hospital Objectives and Disclosures
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
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 informationOvercoming Opioid-Induced Oversedation: More Than Meets the Eye
Overcoming Opioid-Induced Oversedation: More Than Meets the Eye ANCC National Magnet Conference 2013 Jeannine M. Brant, PhD, APRN, AOCN Lisa Peterson, RN-BC, BSN Health Care, Education and Research www.billingsclinic.com
More informationPOST-OP MULTIMODAL PAIN MANAGEMENT. Maripat Welz-Bosna Reading Hospital Medical Center Department of Medicine Hospitalist Services/Pain Management
POST-OP MULTIMODAL PAIN MANAGEMENT Maripat Welz-Bosna Reading Hospital Medical Center Department of Medicine Hospitalist Services/Pain Management Objectives Understand the basic neurobiology of the pain
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationReducing Adverse Drug Events: Strategies to Accelerate Improvement Webinar - Opioid Safety
This presenter has no conflicts of interest to disclose Reducing Adverse Drug Events: Strategies to Accelerate Improvement Webinar - Opioid Safety Frank Federico Vice President August 17, 2017 Objectives
More informationPre-op Interventions to Mitigate Post-op Acute and Chronic Pain
Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain H A R S H A S H A N T H A N N A. M D, M S C A S S O C I A T E P R O F E S S O R D E P A R T M E N T O F A N E S T H E S I A C H R O N I C
More informationAnalgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients?
Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients? Ashraf S Habib, MBBCh, MSc, MHSc, FRCA Associate Professor of Anesthesiology Interim
More informationPain Management and Safe use of opioids in hospitals. Kyoung-Sil Kang, PharmD, BCPS Scott Tam, PharmD Lauve Casimir, RN, MSN
Pain Management and Safe use of opioids in hospitals Kyoung-Sil Kang, PharmD, BCPS Scott Tam, PharmD Lauve Casimir, RN, MSN Bronx Care Health System Bronx Lebanon Hospital Concourse/ Fulton division, Nursing
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 informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationOpioids and Respiratory Depression
Opioids and Respiratory Depression Clinical Committee Society of Anesthesia and Sleep Medicine https://commons.wikimedia.org/wiki/file:mu_opioid_receptor.svg Introduction Opioid-induced respiratory depression
More informationRECENT ADVANCES IN ANALGESIA
4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationOutpatient Total Knee Arthroplasty: Anesthetic Implications
Outpatient Total Knee Arthroplasty: Anesthetic Implications Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of Orthopedic Anesthesia Disclosures None Objectives Examine current
More informationBird M : Acute Pain Management: A New Area of Liability for Anesthesiologist. ASA Newsletter 71(8), 2007.
Citation Bird M : Acute Pain Management: A New Area of Liability for Anesthesiologist. ASA Newsletter 71(8), 2007. Full Text A 71-year-old obese female smoker with hypertension and diabetes underwent a
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
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 informationAcute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance
Acute Pain Management in the Opioid Tolerant Patient Kathleen M. Colfer, MSN, RN-BC Clinical Nurse Specialist Acute Pain Management Service Department of Anesthesiology Thomas Jefferson University Hospital
More informationEnhanced Recovery to Optimize Perioperative Alternatives to Opioids
Enhanced Recovery to Optimize Perioperative Alternatives to Opioids Women in Government, Annual Healthcare Summit Th 05 November 2017, Washington DC Timothy E. Miller, MB, ChB, FRCA Duke University Department
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
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 informationTransitions from Acute to Chronic Pain
Transitions from Acute to Chronic Pain Chronic Post-surgical Pain An Important yet largely unrecognized clinical problem! 1,2 Defined as pain and pain disability persisting more than 3 months after surgery
More informationPost Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark
Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationSufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type
Sufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type 2016 European Society of Regional Anesthesia Congress Maastricht,
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 informationPhysiotherapy Management in Acute Postoperative Pain
Physiotherapy Management in Acute Postoperative Pain Barry Ma Physiotherapist Queen Elizabeth Hospital Postoperative pain management is of supreme importance as it is essential for patients to comply for
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acetaminophen, for geriatric surgical patients, 569 570 Acute kidney injury, critical care issues in geriatric patients with, 555 556
More informationWhat s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
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 informationProfessor Richard Langford Barts and The London NHS Trust. South Thames Acute Pain 10 th Nov 2011
Current Issues in Postoperative Pain Management Professor Richard Langford Barts and The London NHS Trust South Thames Acute Pain 10 th Nov 2011 Types of acute pain Outline issues and unmet clinical needs
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationTHE EAPC OPIOID GUIDELINES: PROCESS, RESULTS AND FUTURE DEVELOPMENT
1 THE EAPC OPIOID GUIDELINES: PROCESS, RESULTS AND FUTURE DEVELOPMENT Jaegtvolden 4-5 June 2012 14. 12. 2012 2 1 3 WHO ANALGESIC LADDER (1996) NSAID +/- Adjuvant STEP II OPIODS Opids for mild to moderate
More informationAcute Postoperative Pain. David Radvinsky, MD March 24, 2016
Acute Postoperative Pain David Radvinsky, MD March 24, 2016 Objectives 1. Discuss the multimodal approach to pain management and discuss the various classes of drugs based on receptor mechanism. 2. Give
More information5 th ERAS UK Conference. Advances in Pain Management. Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh
5 th ERAS UK Conference Advances in Pain Management Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh Pre-op information Optimised organ function No nutritional
More informationClick to edit Master subtitle style
Does Enhanced Recovery Improve Outcomes? Click to edit Master subtitle style Kaare Weber, MD Director of Surgery Associate Medical Director, Surgery A MEMBER OF THE MONTEFIORE HEALTH SYSTEM mes? Click
More informationMultimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P)
1. In the normal gastrointestinal tract, what percent of nutrient absorption occurs in the jejunum? a. 20%. b. 40%. c. 70%. d. 90%. 2. According to Dr. Erstad, the four components of gastrointestinal control
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 informationRole and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
More informationAcute Pain NETP: SEPTEMBER 2013 COHORT
Acute Pain NETP: SEPTEMBER 2013 COHORT Pain & Suffering an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage International
More informationAcute postoperative pain management continues
Hosp Pharm 2014;49(11):1022 1032 2014 Thomas Land Publishers, Inc. www.hospital-pharmacy.com doi: 10.1310/hpj4911-1022 Original Article Impact of Intraoperative Acetaminophen Administration on Postoperative
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 informationAnesthesia for OutPatient Spine Surgery. Michael A. Kellams, D.O.
Anesthesia for OutPatient Spine Surgery Michael A. Kellams, D.O. DISCLOSURE None! Hot Topics 2017 -Multimodal Analgesia/ERAS -TAP block -Inpatient procedures outpatient (Fusions) Multimodal Analgesia -Using
More informationFast-Track Colonic Surgery: Status and Perspectives
Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk
More informationInnovative Approaches and New Technology to Gain Access
Innovative Approaches and New Technology to Gain Access The following is intended only for presentation to the Reimbursement and Access 2017 audience, August 17, 2017. This information is not for promotional
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 informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationPostoperative Pain Management. Nimmaanrat S, MD, FRCAT, MMed (Pain Mgt)
Postoperative Pain Management Nimmaanrat S, MD, FRCAT, MMed (Pain Mgt) Topics to be Covered Definition Neurobiology Classification Multimodal analgesia Preventive analgesia Step down approach Measurement
More informationGabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement. Manyat Nantha-Aree, MD
Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement Manyat Nantha-Aree, MD Objective n Preliminary results of MOBILE study in total hip and knee arthroplasty Background n Gabapentin=
More informationFrederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006.
Frederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006 Introduction Laparoscopic surgery started in the mid 1950s. In recent
More informationScreening - inclusion criteria
PAIN OUT Community research EU ROP EAN COMMISSION A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Room number: Screening
More informationPersistent post surgical pain. Jim Olson Waitemata DHB Auckland
Persistent post surgical pain Jim Olson Waitemata DHB Auckland Declaration Within the last five years I have accepted hospitality from the pharmaceutical industry, received honoraria from Mundipharma NZ
More informationEUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1
PREVENTING PAIN IN NEUROSURGICAL PATIENTS EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 07RC1 SABINE HIMMELSEHER, EBERHARD F. KOCHS Department of Anaesthesiology Technical University Munich
More informationABSTRACT TITLE: Near-OR Perioperative Interventions to Decrease Hospital Length
ABSTRACT NUMBER: 020-0094 ABSTRACT TITLE: Near-OR Perioperative Interventions to Decrease Hospital Length of Stay AUTHORS: Mark J. Lenart, MD Vanderbilt University 1301 Medical Center Drive Nashville,
More informationPostoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged
Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged Jeffrey L. Apfelbaum, MD*, Connie Chen, PharmD, Shilpa S. Mehta, PharmD, and Tong J.
More informationOpioid reduction strategies in an academic tertiary medical center
Opioid reduction strategies in an academic tertiary medical center Terry Bosen, PharmD Medication Safety Program Director Vanderbilt University Medical Center Tennessee MME data per capita MME = Morphine
More informationSingle- and Repeat-Dose Pharmacokinetics of Sublingual Sufentanil NanoTab in Healthy Volunteers
Single- and Repeat-Dose Pharmacokinetics of Sublingual Sufentanil NanoTab in Healthy Volunteers Pamela P. Palmer, MD, PhD AcelRx Pharmaceuticals, Inc. October 20, 2009 1 Sufentanil: A Superior Opioid Approved
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationGUIDELINEs ON PAIN MANAGEMENT IN UROLOGY
GUIDELINEs ON PAIN MANAGEMENT IN UROLOGY (Text update March 2009) P. ader (chair), D. Echtle, V. Fonteyne, G. De Meerleer, E.G. Papaioannou, J.H. Vranken General principles of cancer pain management The
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 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 informationHow to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium
How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare. Does severe acute postoperative pain still
More informationPOLICY All patients will be assessed for risk factors associated with OSA prior to any surgical procedures.
Revised Date: Page: 1 of 7 SCOPE All Pre-Admission Testing (PAT) and Same Day Surgery (SDS) nurses at HRMC. PURPOSE The purpose of this policy is to provide guidelines for identifying surgical patients
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
More informationPersistent Postsurgical and Posttrauma Pain
PAIN CARE Persistent Postsurgical and Posttrauma Pain Chris Pasero, MS, RN-BC, FAAN IT IS ESTIMATED that as many as 50% of patients who have undergone surgery experience persistent pain long after the
More informationHow to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion
How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion Disclosure Slide No COI and no disclosures. Hospital Mortality rate : is it
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More informationAnesthetic Challenges in Morbid Obesity
Anesthetic Challenges in Morbid Obesity The Challenge Postoperative pain management of the morbid obese patient The number of patients who present for elective surgery, with a BMI of greater than 30 kgm
More informationOBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
College of Intensive Care Medicine of Australia and New Zealand ABN: 16 134 292 103 Document type: Training Date established: 2007 Date last reviewed: 2014 OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
More informationDORIS DUKE MEDICAL STUDENTS JOURNAL Volume V,
Continuous Femoral Perineural Infusion (CFPI) Using Ropivacaine after Total Knee Arthroplasty and its Effect on Postoperative Pain and Early Functional Outcomes Eric Lloyd Scientific abstract Total Knee
More informationAnesthetic Risks of Obstructive Sleep Apnea in Children
Anesthetic Risks of Obstructive Sleep Apnea in Children Dawn M. Sweeney, M.D. Associate Professor of Anesthesiology and Pediatrics University of Rochester Medical Center Risk Factors for OSA in Children
More informationEpidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
More informationReducing the risk of patient harm: A focus on opioids
Reducing the risk of patient harm: A focus on opioids New York State Partnership for Patients (NYSPFP) Initiative Regional Educational Session November 2013 1 Disclosure Matthew Fricker, Matthew Grissinger,
More informationRichard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY,
Richard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY, USA Disclosures Off label use: Fentanyl, Sufentanil IT
More informationANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*
Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced
More informationMeasure Abbreviation: PONV 01 (MIPS 430)
Measure Abbreviation: PONV 01 (MIPS 430) *PONV 01 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 430: Prevention of Post-Operative Nausea and Vomiting (PONV) Combination
More informationPatient-controlled analgesia: Is it worth the painful prescribing process?
Pharmacology tes Patient-controlled analgesia: Is it worth the painful prescribing process? Jennifer Craft, PharmD, BCPS In the last 10 years, the assessment and treatment of pain have become a priority
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 informationUpdate Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
More informationPost-operative Analgesia for Caesarean Section
Post-operative Analgesia for Caesarean Section Introduction Good quality analgesia after any surgery leads to earlier mobilisation, fewer pulmonary and cardiac complications, a reduced risk of DVT and
More information