SE1EO-13 Pain Committee Friday, November 4, 2011
Attendance: Dr. Ross, Dr. Jepson; Kate McCord, RN, Rose Ann Moore RN, Mike Force, Pharmacist; Dan Chatelain RN, Kathy Guy RN, Audrey Simpson RN, Deb Nussdorfer RN, Carolyn Cusic RN, Carlos Johnson RN , Allison Schlang, Pharmacist;eanne Rice
Subject / Discussion / Action / ResponsibilityCall to Order / The meeting was called to order at 7:07 am
Review of Minutes / The October 2011 minutes were reviewed and approved as submitted.
Fentanyl charting / Mike Force reported that in PACU, all vials of Fentanyl are now 250 mc. Nurses are charting properly by writing the amount, i.e., 25 mc, 50 mc, etc., to the side. Dan voiced some concerns with 250 mc vials, but it is due to the Fentanyl shortage per Mike. / Information only
Drug Utilization Review for IV Tylenol / Mike announced they will be doing a drug utilization review on IV Tylenol and will have students assist next semester. Mike feels there may be overuse of IV Tylenol; not necessarily abuse, but being administered for too long a period of time. Mike said some Centura facilities have not even added to their formulary. Dr. Jepson feels it has helped the effort toward multi-modal pain control. / Information only
Foley catheter removal & the pain service / Dan is able to write orders for removal of foley catheters. Currently the epidural policy does not address the removal of these. Audrey said that by post-op day two, a written order is required to state why the catheter has not been removed. / Information only
Relistor on 11th floor - add to formulary? / 11th floor physicians will have to make the decision whether to add Relistor to the formulary. At this time, it is available through pharmacy, just not on formulary. / Mike said a physician champion could be designated and help push for this addition to formulary. Dr. Ross stated he would be willing to champion. / Mike Force/Dr. Ross
Revised epidural/ intrathecal order sets / Anesthesia Dept. removed verbage from order sets for repeat doses of ephedrine, with the hope being to use more fluid to stabilize blood pressure. (Copies attached for review.) / Add to next Anesthesia Section agenda (for awareness). / Jeanne Rice
Narcan data / Deb asked for Kathy & Dan to review three cases; feels co-mordibity played a big role, but would like review to see whether we might have done something differently. Seven cases in August, six in September; many RRTs at nine cases. / Deb will call Dr. Ross on Monday and make plans to have him review these three cases. / Deb/Dr. Ross
PRN 2-day conference in Denver / Dan attended this two day conference and feels we are light years ahead of other Centura facilities. Felt that overall it was a very good conference. / Information only
Pain psychiatrist referral / Dan discussed patients who are depressed have much more pain with surgery. He’s discussed the problem of not having any psychiatric support in the hospital with Dr. Mann. Dr. Jepson voiced agreement that a large percentage of his patients suffer from depression. Who could we make available to address prior to surgery? Combining some psychiatric medications with pain meds can be problematic. / Kate said we’re looking at several possibilities: working with Chris Stewart (Ph.D), and perhaps a part-time psychiatrist who will be able to do some rounds (. Dr. Sanford has expressed some interest in coming back. PETT team is only for crises situations.
Status of additional pain nurse / Kathy Guy is working with HR on finding an additional pain nurse. Dan re-emphasized needing help. / Mike Force/Alison Schlang
1-hour reassessment of pain (real world status) / Dan questioned whether the 1-hour reassessments of pain were really occurring. This was a “fall-out” on pain audits per Rose Ann; one documents scale and the other hourly assessments. / Information only
Pain service protocols / Dan thanked Medical Executive Committee for granting approval to the pain service protocols. Orders can now be written per pain service protocol - Dan can now write/put his name next to it; however, no other nurse can do this. / Mike Force will relay to all the pharmacists. Kate said a talking point page will go out to nursing. Dan will send out email to all nursing unit managers. Protocols need to be on the chart.
Add “for use by pain service nurse only” on every sheet of the protocol. Contact Nancetta to add the watermark. / Dan – email to unit mgrs
Nancetta – add watermark
Mike – relay to pharmacy