Authors (including presenting author) :
Wong MC(1), Chan PC(1), Law KL(1), Lau OH(2), Wong YH(3), Lim HS(4)
Affiliation :
(1)KEC Pain Management Centre, (2)Day Surgery Centre, (3)Operating Room, (4)Anaesthesiology and Pain Medicine, United Christian Hospital
Introduction :
Acute pain service (APS) was initiated to provide dedicate care to post-operative patients in 1985. Anesthetists-based and nurse-based APS are commonly used models. Although anesthetists-based model is widely adopted, nurse-based model could also provide safe and cost effective post-operative pain management. In Hong Kong, almost all Hospital Authority hospitals have anesthetist-led, nurse supported APS. Anesthetist-based APS started in late 90s in UCH. In Dec 2016, a “Nurse-based, Anesthetist Supervised Acute Pain Service (nurse-based APS) was proposed and endorsed by Pain Medicine Committee (PMC). Phase one service was commenced in Feb 2017 and its effectiveness was evaluated.
Objectives :
1)To explore the incidence of APS re-consultation after discontinuation of nurse-based APS
2)To explore the compliance rate of the Standard Operating Procedure “Discontinuation of Intravenous Patient Controlled Analgesia (IVPCA) by accredited pain nurses” (SOP)
Methodology :
This was a retrospective service evaluation. Patients with IVPCA after operation and obstetric pain management service (OBS) between February 2017 and January 2018 were included. Exclusion criteria: 1) Patients with epidural and nerve block analgesia; 2) Enhanced Recovery After Surgery (ERAS) programme patients; 3) Essential data were missing from APS database Service development:
Nurse-based APS implementation plan and standard patient assessment templates for IVPCA and OBS were developed and endorsed by PMC. The SOP was developed and endorsed by Drug and Therapeutic Committee. Structure of nurse-based APS:
It runs by one pain nurse and anesthetist, Monday-Friday, 08:12-17:00; pain nurse reviews patients with IVPCA and OBS daily. Used standard patient assessment templates are kept in patients’ medical folders. Patients are discharged from APS when IVPCA is discontinued. The OBS is terminated by pain nurse if patients’ pain control are satisfactory. Anesthetist review patients only if they have inadequate pain control, and oxygen desaturation etc.
Result & Outcome :
Results:
2502 patients received APS between Feb 2017 and Jan 2018. Among these patients, nurse-based APS covered 290 and 621 patients who were using IVPCA and OBS respectively, which accounted for 36.4% of APS patients. Pain nurse discharged 130 IVPCA and 621 OBS patients. The mean resting pain score was 1.3/10 and functional pain score were 3.8/10 and 4.2/10 at the end of nurse-based APS for patients with IVPCA and OBS respectively. There were 100% compliance of the SOP and was no incidence of APS re-consultation. Conclusion:
Nurse-based APS provides safe post-operative pain management. Service extension for ERAS programme patients will be discussed. Cost-effective analysis will be conducted in due course.
Co-location with:
