Authors (including presenting author) :
Kung LP(1), Chu WL(1), Yeung KH(1), Choi CY (1), Chan SC(1),
Affiliation :
(1)Anaesthesia and Operation Theatre Services, Queen Elizabeth Hospital
Introduction :
The routine practice of bringing titrated IV morphine with patient from the operating room to post-anaesthetic care unit (PACU) for postoperative pain relief; and keeping the morphine in an open area at PACU has risk of mix up the drug and leading to wrong administration. Keeping the dangerous drug in an open area is also a problem. A project is started to revise the workflow on handling of IV morphine in PACU between nurses and anaesthetists.
Objectives :
1.Enhance medication safety on dangerous drugs (IV morphine) used in PACU.
2.Promote perioperative pain management with timely and adequate administration of analgesic.
3.Enhance the quality of nursing care by leaning the non-value added workload.
Methodology :
A new workflow on handling of IV morphine in PACU was implemented from 2 May 2018 including, i) no morphine will be brought from theatre to PACU, ii) morphine will be titrated and administrated by PACU nurses according to morphine protocol, iii) and remaining dose will be kept in the new bedside lockable drawer. After implementation of the new workflow, a review was followed to evaluate the compliance to the workflow and the acute pain management after the new workflow.
This project also measured the time PACU nurse spend on handling the unused morphine that bring from theatre to PACU, in together to lean this non-value added workload by introducing the new workflow.
Result & Outcome :
A retrospective review of patient record for those admitted to PACU from 14 May to 25 May 2018 showed 486 patients record having 100% compliance that morphine was discarded in theatre and not brought to PACU. This result vindicated the integrity of new workflow.
Among these, 139 (28.6%) patients have morphine protocol prescribed and 25 (18%) of them required morphine. The mean time from pain score documented to morphine being administered was 4.8 minutes and 15/19 (79%) cases received morphine within 5 minutes which shall be an acceptable time frame. The use of lockable drawer at each bedside secured the safe medication keeping in PACU.
We have also advocated treating patient with timely perioperative pain relief by multimodal regimen. Through this review, there was 45/486 (9.2%) adult patient in PACU required analgesic. As compared with 30/238 (12.6%) patients requiring morphine in PACU before the new workflow, there was positive impact on perioperative pain management
A one week review before the new workflow revealed that 124/154 (80.5%) cases have morphine brought from theatre to PACU that ultimately patient did not needed. The new workflow leaned the workload to handle the unused morphine which could save more nursing times to provide better care to our patient.
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