Introductory Lecture to Patients, Hospital Administration & Anesthesia Dept - CPNB Consulting...

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This introductory presentation outlines the importance of initiating a successful Acute Pain Service (APS) in order to optimize Patient Satisfaction as well as Clinical & Financial Outcomes. The cornerstone of an APS Program that translates into significant outcome differences is a Continuous Peripheral Nerve Block (CPNB). You will not translate your efforts into improved safety or financial gain by taking the 'easy road', by exponentially increasing patient monitoring or by working in a poorly-organized system. If you continue to ignore the consequences of hanging on to the ineffective, costly and dangerous practice of using IV opioids as your primary analgesic agent, you will continue to hemorrhage money from your facility and deliver inferior patient care. There are other important reasons both for Hospital Administrators and Anesthesiologists 'team up' to improve health care in your community. If you are interested in hearing more about how to change your Anesthesia Department from a cost center to a revenue center and provide cutting-edge patient care in your community, contact Dr Jerry Jones at 731-616-8540 or visit our website at "Smart Business. Better Care."

Transcript of Introductory Lecture to Patients, Hospital Administration & Anesthesia Dept - CPNB Consulting...

  • OBJECTIVES 1. 2. 3. 4. Is Pain THAT big of a Problem? What is a Nerve Block Program? How to develop a successful Program Answer you Questions
  • WHO AM I? Private Practice for 11 years Got interested in CPNB in 2007 Developed two CPNB Programs from scratch Affiliate Faculty at Union University Speaker & Consultant to: B Braun, I-Flow, Ambu, others CPNB CONSULTING LLC Treatment Total Healing for David Stanley, MD For many patients with cancer, radiation therapy is a lifesaving treatmentbut killing cancer cells frequently doesnt come without adversely affecting healthy tissue. Fortunately, Methodist Medical Center of Oak Ridges Wound Treatment Center offers hyperbaric oxygen therapy that can help many patients make a total recovery. According to David Stanley, MD, board-certified vascular surgeon and medical director of the MMC Wound Treatment Center, patients undergoing radiation therapy may suffer symptoms related to radiation fibrosisin which tissue become scarred. Symptoms of radiation fibrosis include cystitis or proctitis, which is a condition characterized by pain and bleeding following radiation for prostate, colorectal, and other pelvic cancers, says Dr. Stanley. As time goes by, the fibrosis becomes progressively worse, and even a mild injury to the area can develop into a hard-to-heal wound. Portable Pain Block How We Can Help Dr. Stanley encourages any patient who has undergone radiation therapy and anticipates surgery in that same area of the body to ask their physician for a referral to the Wound Treatment Center for a consultation. Team members can take a transcutaneous oxygen measurement to determine whether healing will occur following surgery. Failure to take this precaution before even just a minor procedure can cause serious complications, Dr. Stanley says. We want to ensure the health and safety of each of our patients. Visit us at and click on the What Our Patients Say tab to see how others have benefited from care at the Wound Treatment Center. Prolongs Relief Many patients who undergo certain surgical procedures at Methodist experience extended pain relief without depending on as much traditional pain medication. Known as the continuous peripheral Jerry Jones, MD nerve block, this new treatment uses nerve-numbing medication that extends the traditional 12- to 15-hour window of pain relief coverage of a single injection nerve block to more than two days. The new pain block is not appropriate for every patient that undergoes surgery. However, it can significantly reduce the need for traditional pain medication when it is appropriately used. We administer the treatment through thin catheters attached to balloon-like pumps, explains Jerry Jones, MD, board-certified anesthesiologist at Methodist Medical Center of Oak Ridge. Those pumps are concealed within a fanny pack and drip the medication through the catheter to a nerve bundle just under the skin for two to three days. 10 MMCO AK RIDG E.CO M FALL/WINTER 2010 .C Providing Exclusive Service According to Dr. Jones, patients can remove the bandage at home and dispose of the entire unit once the treatment is complete. As the only local healthcare provider that makes the continuous peripheral nerve block service available, Dr. Jones says patient satisfaction at Methodist is our highest priority. Our facility optimizes patient treatment by providing superior analgesia pain control through a multimodal regimen, says Dr. Jones. We work to offer our patients the most effective pain control with the least side effects. To read more about this pain block option through the experiences of actual patients, visit and click on the What Our Patients Say tab.
  • PAIN Management
  • WHY PAIN CONTROL IS IMPORTANT Patient satisfaction has always been important, but with Medicare reimbursement being partially dependent on HCAHPS scores, failure to address pain management could literally be detrimental to a hospitals bottom line. Clear correlations between satisfaction with pain control and overall patient satisfaction are abundant in the literature. Hospitals with the top 15% of HCAHPS scores had 26% more patients reporting pain well controlled than the bottom 15% (Healthgrades Press Release, 6-2-09).
  • HOW ARE WE DOING? Acute Pain Management: Programs in U.S. Hospitals and Experiences and Attitudes among U.S. Adults Warfield, Kahn Anesthesiology 1995;83:5:1019-94 500 Adults interviewed 1 year after AHCPR guidelines issued 77% believed it is necessary to experience pain after surgery 57% cited pain after surgery as primary fear (51% whether surgery improve condition) 77% reported pain with 80% of those reporting moderate to extreme! Despite this, pts often reported satisfaction since they expected pain
  • HOW ARE WE DOING? Postoperative Pain Experience: Results from a National survey Suggest Postoperative Pain Continues to Be Undermanaged Apfelbaum et al Anesthesia & Analgesia 2003;97:534-40 250 adults who had surgery within 5 years representative of U.S. 80% had acute pain after surgery, 58% before & 75% after D/C home* 86% was moderate, severe, extreme, 39% severe (same if >1 yr ago use of supplies, medications - > manpower (time & interventions) Prolonged Recovery/Return to ADL - Greater bone/muscle loss - Opportunity for secondary complications F Perkins, H Kehlet Chronic Pain as an Outcome of Surgery A Review of Predictive Factors Anesthesiology 2000;93:1123-33 G Joshi et al Consequences of Inadequate Postoperative Pain Relief & Chronic Persistent Postoperative Pain Anesthesiology Clinics North Americ2005;23:21-36 R Ritchey Optimizing Postoperative Pain Management Cleveland Clinic Journal of Medicine 2006;73:1: S72-6
  • IMPACT OF ACUTE PAIN Delays in Wound Healing - Catabolic state, Vasoconstriction, Collagen Deposition, Immobilization, Low- O2 Tension L McGuire et al Pain & Wound Healing in Surgical Patients. Ann Behavioral Medicine 2006;31:165-72 K Woo; R Sibbald The Improvement of Wound-Associated Pain and Healing Trajectory With a Comprehensive Foot and Leg Ulcer Care Model. Journal of Wound, Ostomy & Continence Nursing 2009; 36:2: 184-91 Nimmo WS, Duthie DJ. Pain relief after surgery. Anaesth Intensive Care 1987; 15(1): 68-71. Disrupted Sleep & Worsened Pain - Opioids Disrupt Sleep Further, Worsening Pain Moore & Kelz Opiates, Sleep, and Pain: The Adenosinergic Link Anesthesiology 2009;111:6:1175-6 Nelson et al Opioid-induced Decreases in Rat Brain Adenosine Levels Are Reversed by Inhibiting Adenosine Deaminase Anesthesiology 2009;111:6:1327-33
  • NEUROENDOCRINE STRESS RESPONSE CARDIOVASCULAR* (>BP, HR, SVR, CVA & ischemia risk) RESPIRATORY* (> work of breathing) GASTROINTESTINAL (ileus, nausea) URINARY (retention) HEMATOLOGIC (hypercoagulable, > DVT/PE risk) IMMUNE* (depressed, > cancer spread/recurrence) ENDOCRINE (> Cortisol, ADH, Epi = catabolic state, negative N balance & nutrition status) WELL-BEING (anxiety, poor sleep, worsened pain perception, immobility) AROUSAL & ENDOGENOUS OPIOIDS B-blockers good, but limited in scope (too late & affects too few areas)
  • CHALLENGE OF PAIN MANAGEMENT BALANCE: the pain problems & the pain treatment problems No objective monitor for pain! Want to minimize Negative Side-Effects of Opioids Avoid ADE & Safety Issues Inter-patient response to Opioids is very variable As well, Avoid Side-Effects of Adjunct therapies GI, Renal, Coagulation, Fracture-Healing, Sedation Epidural: immobility, coagulants, infection, hypotension, foley GOAL: Optimize recovery economically & D/C early
  • COST OF HOSPITAL COMPLICATIONS Acute mental health changes - $3,206 In-hospital trauma & fractures (fall)- $5,370 Renal failure without dialysis - $9,934 Venous thrombosis - $15,976 Pneumonia - $16,901 Decubitis ulcer - $28,272 (Healthcare Financing Review, Summer 2009, Vol. 30, #4, 17-32)
  • CHALLENGE OF USING OPIOIDS Central effect, so helpful for pain anywhere Central effect, so side-effects are everywhere Hypotension, Respiratory, Ileus, PONV, Confusion, Sedation, Itching Easier to titrate for static conditions (like convalescing) Difficult for dynamic pain (cough, OOB, ambulating, active P.T.) Enough to tolerate P.T. = Too sedated to do P.T. Higher doses lead to > Monitoring & > Cost
  • ECONOMICS OF USING OPIOIDS Opioid-Related Adverse Drug Events in Surgical Hospitalizations: Impact on Costs and Length of Stay. Ann Pharmacother, 2007, Odera, G.M. RESULTS: Patients experiencing opioid-related ADEs had significantly increased median total hospital costs (7.4% increase; 95% CI 3.83 to 10.96; p < 0.001) and increased median LOS (10.3% increase; 95% CI 6.5 to 14.2; p < 0.001) compared with matched non-ADE controls. Higher doses of opioids were associated with increased risk of experiencing ADEs (OR 1