UCSF: 150 years in the making
|
|
- Dwain Atkins
- 5 years ago
- Views:
Transcription
1 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 & Perioperative Care Medical Director, UCSF Pain Services University of California, San Francisco School of Pharmacy: S. VanOsdol Pharm.D. Clinical Pharmacy: H. Windham Pharm.D. PACU Nursing: S. Brynelson RN Unit Nursing: M. Eckhaus RN IP3 Drs. K. Sun, C. Kim, S. Wilson NPs Nicole Hodgeboom, M. Comstock Division Pain Medicine R. Naidu & Faculty Division of Palliative Care S. Pantilat UCSF: 150 years in the making UCSF: The Health Care System Parn Zion MB SFVA SF General Hospital MB Founded in
2 UCSF: Benioff Children s Hospital Feb 2015 Zion MB U UCSF nder C onstruction S ometimes F inished Challenges: The Institution - UCSF Challenges: Inpatient Pain Care UCSF is Too Large to: Innovate? Manage? Despite being a leader in Medicine, Pharmacy, Nursing, Dentistry Historically - UCSF inpatient clinical pain management was focused on primarily opioids. Provide Personalized Care? 2
3 Challenges: Inpatient Pain Care Challenges: The ideal analgesic does not yet exist What system level practices are at play driving opioid related unwanted side effects? Can we develop an institutional approach for reducing the burden of opioids to our patients? Is there a better way to manage pain that balances opioids with other modalities? - Acts selectively on the pain-sensing nerves -Does not depress CNS - respiration -Use over time maintains analgesia -Easy to administer -Is not addictive -Low Cost $$ Challenges: Ketamine: NMDA antagonist High dose (IV Bolus): Dissociative: 1-2 mg/kg Anesthetic: 2-5mg/kg What other strategies are in our tool box to reduce the opioid burden? Moderate dose (Analgesia): (IV bolus) mg/kg iv Low-dose Ketamine Low dose (Opioid sparing): 1-5 mcg/kg/min (IV Infusion) or mg/kg/hr 3
4 Challenges: Where we started Outcomes: Low dose Ketamine (3 ug/kg/min ) Consult We have a 27 yo F in the ICU on Fentanyl (7000ug/hr) 3.4 L /day! Reversal of Fentanyl-Induced Tolerance by administration of Small-Dose Ketamine (Eilers et al., Anesth Analg 93 (1) p ) Low dose Ketamine Opioid tolerant Spinal fusions: placebo vs low dose ketamine (0.2mg/kg induction then 2 ug/kg/min x24hr) in opioid tolerant pts Both groups hydromorphone PCA Less pain in PACU, POD1 at rest and activity Decreased hydromorphone requirement Challenges: How to Start? Who is in charge?.. You are!.. and you ll need to find some interested partners Urban
5 Pain Management is interdisciplinary Need to link: Providers Nurses Pharmacy Patients Challenges: Critical Systems: Medical Director Pain Services Acute Pain Services Provider Champion(s) Pain Management Committee Clinical Nurse Specialist Pain Unit Nurse Manager Critical Systems Components Clinical Nurse Specialist (CNS) - Pain Co-Chair Nursing pain education Meets with Pain Resource Nurses Intended to assess and disseminate innovation around analgesic therapy Challenges: Where to Start? Focus on Opioid Safety > Quality Critical Events Incident Reports - Respiratory Depression -Increasing use of naloxone 5
6 P u bli shed : D ecem ber Editor: Adrienne Green, MD, SFHM Associate Chief Medical Officer Chair, Patient Safety Com mittee October 2011 Volume 1, Issue 3 Work of the Pain Management Committee SAN DIEGO PATIENT SAFETY TASKFORCE Challenges: Pain Management NEW Adult PCA Order Changes TOOL KI T For use in patients > 40 kg P atient Controlled Analgesia (PCA) Guidelines of What: Care For the Opioid Naïve P atient PCA 6 > 10 The Delay and One Hour Limit on the Adult PCA Orders form are being changed. The delay times (lock out times) are being increased from 6 minutes to 10 minutes. What: For OPIOID NAÏVE patients: It is recommended to select MORPHINE SULFATE as a first choice (unless history of allergy, unwanted side effects or renal dysfunction. ADULT PATIENT CONTROLLED ANALGESIA: Why: A longer delay time is a safer practice and a. Morphine Sulfate is the first choice for opioid naïve patients without renal dysfunction. matches community and national standards. b. Fentanyl is the first cho ice for opioid naïve patients with renal dysfunction. Why: When initiating an opioid analgesic, Mor phi ne Sulf at e c. Hydromorphone is an alternative for opioid tolerant patients or patients appears the safest choice in opioid naïve patients. unresponsive to Morphine Sulfate. Fen t anyl is the recommended choice in opioid To improve naïve patient safety, a revised Adult Patient Controlled Analgesia IV Opioid patients with renal dysfunction. Hyd ro m ororder ph one Form is will an be rolled out on Oct. 28th. alternative often used in opioid tolerant patients. When: New PCA order forms will be replacing the current forms on Oct ober 2 7t h & 28t h Questions: Pain Service: ; Pain Management Committee / M. Schumacher MD PhD schumacm@anesthesia.ucsf.edu A NEW ORDER FORM FOR ADULTS > 40 KGS The use of Patient Controlled Analgesia (PCA) is a high risk therapy frequently used in post-operative care. At UCSF and nationally it has been associated with significant adverse events and death. In response to trends in post-operative patients at UCSF a review of Patient Controlled Analgesia prescribing practices has recently been completed and new guidelines for Adult PCA orders have been developed. Key safety improvements include: 1. The Delay and One Hour Limit have been changed to align with community and national standards. The delay time (lock-out time) has been increased from 6 minutes to 10 minutes. The one hour limit has thus been appropriately decreased for each medication choice. 2. New recommendations for Opioid Naïve Patients: A hard stop will be placed on orders submitted on the old order form on Monday November 14 th. Rationale: A longer delay time improves safety by preventing dose stacking. Using Hydromorphone in opioid naïve patients has been shown to increase adverse outcomes. Hydromorphone has been associated with increased rates of respiratory depression in early post-op patients. High risk patients include those with age >65, COPD, renal disease, CHF and OSA. Use caution in dosing opioids in patients with renal dysfunction. In general, dose reductions are required for morphine and hydromorphone when CrCl <=30. Please consult the Pain Service or Pharmacy for assistance with dosing. Questions: M/L Acute Pain Service: ; Mt. Zion Acute Pain Service: Pain Management Committee / M. Schumacher MD PhD schumacm@anesthesia.ucsf.edu First Do No Harm Is it really just simple (analgesic) economics? Supply vs Demand Supply How provider s order analgesics vs Demand What are patients analgesic requirements? Challenges: Decreasing Opioid Demand while Improving Quality Goal: Introduce non opioid strategies to improve the quality of analgesia while reducing opioid requirements Where to Start? Unit with high levels of post-operative pain, highest opioid use, greatest number of opioid-related critical events, variable patient satisfaction General Surgery NPO, Ortho Spine Opioid Tolerance Patient Related Potential Benefits Decreased opioid use / side effects Improved PT Early mobilization System Related Decreased Length of Stay (LOS) Reduced transfer to SNF Improved patient Satisfaction Cost Savings 6
7 Challenges: Critical Systems Challenges: Integration of Care Medical Director Pain Services Pain Management Committee No single protocol will change a hospital s culture P & T Committee Acute Pain Services IP3 Clinical Nurse Specialist Pain Unit Nurse Manager Outcomes: low-dose ketamine Outcomes: low-dose ketamine Approval Pilot ketamine (1-5 mcg/kg/min) Designated Providers / Service Controlled by Pain Services Palliative Care Services Initially 4 units: General Surgery Palliative Care Pediatric / Onc Zion Med/Surg Report back to P & T of Pilot (~ 30 pts) Approval for official use on Original 4 units plus expansion to 4 additional units (all with CPO) Finally: Approval for Medical Center use following completion of in-service, CPO, continued oversight by Pain Services Palliative Care. Retrospective review ongoing 7
8 Challenge: Case Mr. T 34yo M h/o rectal CA s/p APR Chronic pain Oxycontin 60mg BID, Intermittently on methadone Oxycodone 60mg q4h PRN, Escalating opioid dose, constipation, concerns for opioid-induced hyperalgesia Epidural placed, low-dose ketamine infusion started POD 15 with great improvement in pain Hospital discharge 1 week later Challenge: Patient VG 19 yo with h/o desmoplastic small blue round cell tumor dx 7 years ago s/p chemo, surgical resection, autologous transplant, radiation. Admitted in Jan 2013 due to 4 month history of abdominal fullness and abdominal pain. Found to have significant ascites and recurrence of her tumor. Admitted for worsening pain and bowel obstruction. Admitted for worsening pain and bowel obstruction. Increase in hydromorphone requirement ~300mg IV/day Constipation likely due to increased opioid requirement Increase in hydromorphone requirement ~300mg IV/day Constipation likely due to increased opioid requirement Ketamine started 3mcg/kg/min Reduced requirement of Hydromorphone use 300mg IV to 20mg IV within 4 days. Consider Transfer to Hospice Outpatient 8
9 Transferred to George Mark Children s House IV ketamine administration outpt Free standing pediatric hospice No previous experience with ketamine infusion Specialist back up resources at UCSF PNP- during the day M-F MD- at night and weekends Dream Foundation Hospice to Disneyland Lessons Learned: Hospice to Home!!! But no home nursing provided Bi-weekly phone checks- working An agent initially restricted to the ICU was transformed to fulfill a family wish and return pt comfortably to home Unexpected benefits that extend beyond the initial plan 9
10 Lessons Learned: Low-Dose Ketamine Patient Selection and Expectations Provider Expectations & Education Managing side effects (Few and dose dependent) Visual changes nystagmus Locked in feeling Illusions vivid dreams Ongoing review of data by whom? A Work in Progress Lessons Learned: We are expanding its use to Ortho-spine patients with significant opioid tolerance Sickle Cell Anemia patients with significant opioid tolerance May have a role in opioid naïve patients undergoing major abdominal surgery Palliative adult and pediatric patients Lessons Learned: Systems Broad Participation from Admin - House Staff / Chairs Improve non-pharmacy interventions Integrate multi-modal pain therapies Reassess approach / med rec for chronic pain patients Educate staff about who to contact to troubleshoot pain Improve / establish pain care resource network Lessons Learned: Communication Reinforce your innovation and message 10
11 Thank You 11
Lumbar 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 informationPain management. Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD
Pain management Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD Case #1 61 yo man with history of Stage 3 colon cancer, s/p resection and adjuvant chemotherapy with FOLFOX
More informationUse of PCA devices in Difficult Populations
Use of PCA devices in Difficult Populations Diane M. Santangelo MS RN ANP-C Stony Brook University Medical Center Acute Pain Service September 10, 2011 1 PCA technology? Why Bother? Costly Nurses complain:
More informationTHA Medication Safety Summit 2018 Journey to an Opioid-Light Emergency Department
THA Medication Safety Summit 2018 Journey to an Opioid-Light Emergency Department Dawn M. Waddell, PharmD, BCPS Clinical Pharmacy Manager Baptist Memorial Hospital Memphis I have no conflicts of interest
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 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 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 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 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 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 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 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 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 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 informationAn overview of Medication Assisted Treatment (MAT) and acute pain management on MAT
An overview of Medication Assisted Treatment (MAT) and acute pain management on MAT Goals of Discussion Recognize opioid use disorder (OUD) Discuss the pharmacology of medication assisted treatments (MAT)
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 informationEffective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA,
Effective Postoperative Pain Management for Children Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will
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 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 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 informationPatient Safety - IV Opioid Use in Hospitalized Patients. October 2014
Patient Safety - IV Opioid Use in Hospitalized Patients October 2014 Objectives List reasons that necessitated development of risk assessment State a few risk factors or medical conditions from the IV
More informationAssessment. Consults & Referrals
University of Virginia Health System Clinical Pathway: Whipple Enhanced Recovery After () LOS: 4-5 days Date of Origin/Revision: June 29, 2016/September 6, 2017/January 31, 2018 : SAS : : : D1 D2 D 3/
More informationPCA PRESCRIPTION is valid for a maximum of 4 days unless ceased earlier. Date: BINDING MARGIN - NO WRITING BINDING MARGIN - NO WRITING
Attach ADR Sticker THESE INSTRUCTIONS EXPLAIN WHEN TO MAKE A CLINICAL REVIEW OR RAPID RESPONSE CALL, YOUR LOCAL ESCALATION PROTOCOL WILL EXPLAIN HOW TO MAKE A CALL PCA ALLERGIES & ADVERSE DRUG REACTIONS
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 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 informationConflict of Interest. Background. Objectives. Adverse Events 10/20/2015
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
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 informationAdolescent Substance Abuse
Adolescent Substance Abuse WHY IT S A PROBLEM AND WHAT WE NEED TO KNOW AS ANESTHESIA PROVIDERS BRIDGET L. MULDOWNEY MD ASSISTANT PROFESSOR OF ANESTHESIOLOGY UNIVERSITY OF WISCONSIN- SCHOOL OF MEDICINE
More informationPractical Tools to Successfully Taper Prescription Opioids. Melissa Weimer, DO, MCR
Practical Tools to Successfully Taper Prescription Opioids Melissa Weimer, DO, MCR Objectives Understand how to calculate morphine equivalents per day Understand the steps necessary to plan a successful
More informationChanging the Face of Palliative Care in Oncology Practice
Changing the Face of Palliative Care in Oncology Practice Karin Porter-Williamson MD Associate Professor of Medicine Medical Director Palliative Care Services KU Hospital Amy Velasquez RN BSN OCN Allen
More informationHigh-Alert Medications: A Look at the Safe Use of Narcotics. Allen Vaida, BSc, PharmD Institute for Safe Medication Practices (ISMP)
High-Alert Medications: A Look at the Safe Use of Narcotics Allen Vaida, BSc, PharmD Institute for Safe Medication Practices (ISMP) Risk Identification in Healthcare The detection of a potential or actual
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 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 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 informationFailure Modes Effects Analysis of Morphine Prescribing
Failure Modes Effects Analysis of Morphine Prescribing Hilary Writer MD FRCPC Elaine Wong BScPhm CPSI Patient Safety and Quality Improvement Forum,14 April 2010 Outline Rationale Medication Incidents with
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 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 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 informationClinical Staff Executive Committee MEDICAL CENTER POLICY NO A. SUBJECT: Pediatric Pain Assessment and Management
Clinical Staff Executive Committee MEDICAL CENTER POLICY NO. 0318 A. SUBJECT: Pediatric Pain Assessment and Management B. EFFECTIVE DATE: April 1, 2014 This policy applies to all neonatal and pediatric
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 informationIntractable pain syndrome is defined as persistent pain despite all the reasonable efforts to treat.
Difficult Pain Syndrome/Intractable/Refractory Pain Intractable pain syndrome is defined as persistent pain despite all the reasonable efforts to treat. Reasonable efforts Differs for specialties/regions/countries
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 informationOpioid Use in Serious Illness
Opioid Use in Serious Illness Jeanie Youngwerth, MD University of Colorado School of Medicine Associate Professor of Medicine, Hospitalist Director, Palliative Care Service Associate Director, Colorado
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 information16 th Annual IHA Stakeholders Meeting Session 2C
16 th Annual IHA Stakeholders Meeting Session 2C September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner: Medication Adherence AppleCare Pharmacy Programs Confidential and proprietary.
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 informationThe Pain of Pain: or Patience for Patients
The pain of pain or: Patience for Patients Alan Bielsky Objectives Discuss mechanisms of acute on chronic pain Explain the practical use of multimodal analgesia Detail different regimens that may benefit
More informationINTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE
INTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE Acute Pain Service-LHSC VH and UH sites HISTORY Lidocaine and procaine used by IV infusion in the 1950s and 1960s for general analgesia Often continued
More informationObjectives. Patient Controlled Analgesia (PCA) Management in the Seriously Ill. Discuss principles for opioid dosing and titration for acute pain
Patient Controlled Analgesia (PCA) Management in the Seriously Ill Jeanie Youngwerth, MD University of Colorado School of Medicine Associate Professor of Medicine, Hospitalist Associate Director, Colorado
More informationEnhanced Recovery After Surgery Getting it Right
Enhanced Recovery After Surgery Getting it Right Aalok Agarwala, M.D., M.B.A. Division Chief, General Surgery Anesthesia Associate Director, Quality and Safety, MGH DACCPM Assistant Professor, Harvard
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 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 informationPalliative Emergencies. Ken Stakiw
Palliative Emergencies Ken Stakiw Disclosure None to disclose for this lecture Have received honoraria from a number of agencies and companies previously Intend to discuss some off label use of medications
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 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 information1
Disclosures I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with
More informationRoad Blocks in Non-Cancer Palliative Care Obstacles observed from outpatient non-cancer palliative practice.
Road Blocks in Non-Cancer Palliative Care Obstacles observed from outpatient non-cancer palliative practice. 25th Annual Palliative Education and Research Days, West Edmonton Mall. Edmonton. 2014 Amanda
More information1/21/14. Cancer Related Pain: Case-Based Pharmacology. Conflicts of Interest. Learning Objective
Cancer Related Pain: Case-Based Pharmacology Jeannine M. Brant, PhD, APRN, AOCN Oncology Clinical Nurse Specialist Nurse Scientist Billings Clinic Conflicts of Interest Jeannine Brant has served on the
More informationImproving Pain Management: The UCSF Journey
Improving Pain Management: The UCSF Journey April 2014 Adam Cooper, RN, MSN Clinical Nurse Educator Institute for Nursing Excellence UCSF Medical Center After this discussion, learners will be able to:
More informationCare of the Dying. For dosing in severe renal impairment see separate guidance for care of the dying in severe renal failure.
Care of the Dying Early diagnosis of the dying process allows for adequate preparation of the patient, the family and the carers. This clinical guidance covers the prescribing and management of patients
More informationThe Participant will be able to: All Better!: Pediatric Adenotonsillectomy Pain Management
All Better!: Pediatric Adenotonsillectomy Pain Management Deborah Scalford, RN, MSN The Children s Hospital of Philadelphia Objectives The Participant will be able to: Identify reasons why pain is unrelieved.
More informationThe Pain of a Fractured Neck of Femur. Ms Fiona Nielsen- Project Lead
The Pain of a Fractured Neck of Femur - Project Lead Our health service 75,000 in-patients 165,000 out-patients 900 beds 6,200 staff 70,000 emergency attendances #NOF Presentations 2010-2011- 262 2011-2012-
More informationReducing Adverse Drug Events Related to Opioids: An Interview with Thomas W. Frederickson MD, FACP, SFHM, MBA
Reducing Adverse Drug Events Related to Opioids: An Interview with Thomas W. Frederickson MD, FACP, SFHM, MBA Iyer Hi, this is a podcast from the Physician-ient Alliance for Health & Safety. The podcast
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 informationImproving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice
Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice Christine M. Groth, Pharm.D., BCCCP NYS Partnership for Patients September
More informationComprehensive Assessment with Rapid Evaluation and Treatment: Integrating palliative care into the care of patients with advanced cancer Leslie J
Comprehensive Assessment with Rapid Evaluation and Treatment: Integrating palliative care into the care of patients with advanced cancer Leslie J Blackhall MD MTS Section Head, Palliative Care University
More informationFairview Southdale Hospital Total Points: 50 RN/LPN Medication Assessment Passing: 45
Fairview Southdale Hospital Total Points: 50 RN/LPN Medication Assessment Passing: 45 1. Your diabetic patient is to be started on an insulin drip at 8 units/hour. The insulin is supplied: 100 units in
More informationWelcome Charles Kennedy
Welcome Charles Kennedy Comoderators Girish P. Joshi, MBBS, MD, FFARCI Professor of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas, Texas David E. Beck, MD, FACS
More informationReducing COPD Exacerbation Readmissions in a Community-Based Teaching Hospital
Reducing COPD Exacerbation Readmissions in a Community-Based Teaching Hospital Dawn Waddell, PharmD, BCPS Clinical Pharmacy Manager Lisa Kingdon, PharmD, BCPS Clinical Pharmacy Specialist Dawn Waddell
More informationPotential disruption from private exchanges and narrow networks. In 2011, less than 10% of companies used High Performing Networks (narrow networks)
1 3 2 Potential disruption from private exchanges and narrow networks. In 2011, less than 10% of companies used High Performing Networks (narrow networks) and in 2014 estimated to be 40%. By 2018, that
More informationOpioid Case Studies. Thomas P. Pittelkow, D.O., M.P.H. Mayo Clinic College of Medicine Rochester, MN. September 29, MFMER slide-1
Opioid Case Studies Thomas P. Pittelkow, D.O., M.P.H. Mayo Clinic College of Medicine Rochester, MN September 29, 2016 2015 MFMER slide-1 Disclosures Relevant Financial Relationship(s) None Off Label and/or
More informationUCSF Pain Summit Multidisciplinary Approach to Acute and Chronic Pain
Multidisciplinary Approach to Acute and Chronic Pain UCSF NIH Center of Excellence in Pain Education (CoEPE) UCSF Pain Research Group May 16, 2013, 8:30am-3:30pm Millberry Union, City Lights and Golden
More informationObjectives: What is your Definition of Pain? 8/16/2017
Safe Opioid Management for the Seriously Ill Patient Sam Perna, D.O. Objectives: MDB1 1) Participants will understand the way the body s pain system works. 2) Participants will identify the elements of
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 informationEarly Goal Directed Sedation In Critically Ill Patients
Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology
More informationResearch and Innovation in Aging Forum December 15, 2015
Palliative Care: Evaluating Regional Initiatives to Reduce Hospital Utilization Ray Viola, MD Division of Palliative Medicine Department of Medicine Research and Innovation in Aging Forum December 15,
More informationMedicines Optimisation Strategy
Clinical Reducing Dosing Errors with Opioid Medicines (Controlled Drug SOP): Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic
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 informationMulti-Modal Pain Management
Multi-Modal Pain Management July 14th, 2017 Todd Edmiston, MD Disclosures None Fellowship training in Sports and Adult Reconstruction Director of Orthopaedic Center, South Baldwin Regional Medical Center,
More informationManaged Care Pushes for Safer Opioid Oversight
Page 1 of 6 Clinical AUGUST 11, 2017 Managed Care Pushes for Safer Opioid Oversight High-risk pain Rx eyed Denver Health systems haven t escaped the nation s ongoing opioid crisis, as evidenced by surging
More informationEnhanced Recovery after Surgery
Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient
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 informationPain Control After Surgery. Patient Information
Pain Control After Surgery Patient Information What is Pain? Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body s way of sending a warning to your brain.
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 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 informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 4000-3 Program Opioid Overutilization Cumulative Drug Utilization Review Criteria Medication Includes all salt forms, single and
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 informationPAIN MANAGEMENT Person established taking oral morphine or opioid naive.
PAIN MANAGEMENT Person established taking oral morphine or opioid naive. Important; it is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
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 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 informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management. March 21, 2013
ADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management March 21, 2013 Agenda, March 21, 2013 Welcome Collaborative education overview Post-operative
More informationGuidelines: EOLC Symptom Control for Patients with Normal Renal Function (in Wandsworth)
Guidelines: EOLC Symptom Control for Patients with Normal Renal Function (in Wandsworth) Policy Number : DC020 Issue Date: October 2014 Review date: October 2016 Policy Owner: Head Community Services Monitor:
More informationPain Management in Hospice and Palliative Care
Pain Management in Hospice and Palliative Care A Case-based Approach JoAnne Nowak, M.D. Merrimack Valley Hospice Revised November 2011 Objectives Use a case study approach to stimulate discussion and illustrate
More informationPain is a common complication
Section Editors: Heather M. Hylton and Wendy H. Vogel Ketamine Protocol for Palliative Care in Cancer Patients With Refractory Pain BRIGHTON A. LOVEDAY, MSN, ANP-BC, AOCNP, ACHPN, APRN, and JILL SINDT,
More informationNew Guidelines for Prescribing Opioids for Chronic Pain
New Guidelines for Prescribing Opioids for Chronic Pain Andrew Lowe, Pharm.D. CAPA Meeting October 6, 2016 THE EPIDEMIC Chronic Pain and Prescription Opioids 11% of Americans experience daily (chronic)
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 informationSafe use of opioids at Capital & Coast District Health Board (DHB)
Safe use of opioids at Capital & Coast District Health Board (DHB) Caroline Tilah Acting Director (Operations), Quality Improvement and Patient Safety (QIPS) Directorate CCDHB 21/10/2014 - Safe Use of
More informationSafe IV Opioid Titration in Patients With Severe Acute Pain
PAIN CARE Safe IV Opioid Titration in Patients With Severe Acute Pain Chris Pasero, MS, RN-BC, FAAN PROVIDING EFFECTIVE PAIN control while minimizing opioid-induced adverse effects in patients with severe
More informationOPIOID- INDUCED NEUROTOXICITY*
OPIOID- INDUCED NEUROTOXICITY* Sriram Yennu MD, MS, FAAHPM Palliative Care, Rehabilitation and Integrative Medicine U.T. M.D. Anderson Cancer Center *Slide Deck courtesy Dept PRIM MDACC PATIENT #1: MRS
More information