Prescreening to Identify the Perioperative Patient on Chronic Opioid Therapy Using Sustained-Release Opioids: An Evidence-Based Approach

9.25
Hdl Handle:
http://hdl.handle.net/10755/201673
Type:
Presentation
Title:
Prescreening to Identify the Perioperative Patient on Chronic Opioid Therapy Using Sustained-Release Opioids: An Evidence-Based Approach
Abstract:
(41st Biennial Convention) Practice Question:  Identify if prescreening the chronic pain patient before the day of surgery is safer and would increase patient satisfaction with pain control.  Background:  There is no standardized approach to managing perioperative pain in the chronic pain patient on sustained-release opioids.  A pre-anesthetic interview is done by telephone before surgery to verify the patient’s health history and identify medications.  The anesthesiologist reviews the assessment on the day of surgery and provides analgesics according to their preferences.  Analgesic gaps are created if the patient omits their morning pain medicine, the anesthesia provider doesn’t compensate for the missed doses, and the surgeon writes a postoperative analgesia order that doesn’t consider their patient’s chronic pain condition.  The patient may be dissatisfied with the pain management received during the surgical visit and is at risk for withdrawal symptoms if treated the same as an opioid-naïve patient. EBP Model:  The Johns Hopkins Nursing EBP Model.  A literature search produced 42 articles which were narrowed to 2 (Level 4 A/B) clinical practice guidelines and 10 (Level 5 A/B) reviews.  Results:  Identifying chronically opioid-consuming patients is the responsibility of the entire perioperative team.  Preoperative evaluation is necessary to document daily opioid use and plan perioperative pain medicine management.  Practice Recommendations:  Pre-hospital nurses can identify surgical patients on chronic opioid therapy using sustained-release opioids.  A sticker placed on the inside cover of the patient’s chart will remind the anesthesia provider and surgeon that the patient is on chronic opioid therapy, to expect higher perioperative opioid usage, and to take the patient’s baseline requirements into consideration as well as acute pain.  A pain management reference guide and pain team consult form can be included in the chart to assist the surgeon in writing appropriate and safe postoperative orders.  Recommendations went into effect in October 2010.
Keywords:
opioid tolerant; postoperative pain management; opioid dependent
Repository Posting Date:
11-Jan-2012
Date of Publication:
4-Jan-2012
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePrescreening to Identify the Perioperative Patient on Chronic Opioid Therapy Using Sustained-Release Opioids: An Evidence-Based Approachen_GB
dc.identifier.urihttp://hdl.handle.net/10755/201673-
dc.description.abstract(41st Biennial Convention) Practice Question:  Identify if prescreening the chronic pain patient before the day of surgery is safer and would increase patient satisfaction with pain control.  Background:  There is no standardized approach to managing perioperative pain in the chronic pain patient on sustained-release opioids.  A pre-anesthetic interview is done by telephone before surgery to verify the patient’s health history and identify medications.  The anesthesiologist reviews the assessment on the day of surgery and provides analgesics according to their preferences.  Analgesic gaps are created if the patient omits their morning pain medicine, the anesthesia provider doesn’t compensate for the missed doses, and the surgeon writes a postoperative analgesia order that doesn’t consider their patient’s chronic pain condition.  The patient may be dissatisfied with the pain management received during the surgical visit and is at risk for withdrawal symptoms if treated the same as an opioid-naïve patient. EBP Model:  The Johns Hopkins Nursing EBP Model.  A literature search produced 42 articles which were narrowed to 2 (Level 4 A/B) clinical practice guidelines and 10 (Level 5 A/B) reviews.  Results:  Identifying chronically opioid-consuming patients is the responsibility of the entire perioperative team.  Preoperative evaluation is necessary to document daily opioid use and plan perioperative pain medicine management.  Practice Recommendations:  Pre-hospital nurses can identify surgical patients on chronic opioid therapy using sustained-release opioids.  A sticker placed on the inside cover of the patient’s chart will remind the anesthesia provider and surgeon that the patient is on chronic opioid therapy, to expect higher perioperative opioid usage, and to take the patient’s baseline requirements into consideration as well as acute pain.  A pain management reference guide and pain team consult form can be included in the chart to assist the surgeon in writing appropriate and safe postoperative orders.  Recommendations went into effect in October 2010.en_GB
dc.subjectopioid toleranten_GB
dc.subjectpostoperative pain managementen_GB
dc.subjectopioid dependenten_GB
dc.date.available2012-01-11T10:46:35Z-
dc.date.issued2012-01-04en_GB
dc.date.accessioned2012-01-11T10:46:35Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.