SE1EO-15 Pain Committee Friday, January 6, 2012 Penrose Board Room
Attendance: Drs. Ross, Finn, Mann, Oram-Smith; Kate McCord, Mike Force, Rose Ann Moore, Dan Chatelain, Kathy Guy, Deb Nussdorfer, Carolyn Cusic, Carlos Johnson, Mike Force, Alison Schlang, Jeanne Rice
Subject / Discussion / Action / ResponsibilityCall to Order / The meeting was called to order at 7:05 am / Dr. Ross introduced his partner, Dr. Ken Finn.was introduced by Dr. Ross.
Review of Minutes / The December 2011 minutes were reviewed and approved as submitted.
Narcan data / One incident of 82 yo male who received morphine PCA and ended up on a ventilator. Morphine not a good choice for elderly patients. / Information
Relistor / Dr. Ross completed paperwork on adding Relistor to formulary and it was given to Alison Schlang in Pharmacy. / PT&D meeting in January at which time it will be reviewed. / Dr. Ross/Mike Force
Nucynta ER / ER version not on formulary. Discuss at January meeting per Alison. / Add to January PT&D agenda. / Alison Schlang/Dan Chatelain
Protocol for patients on high dose opioids / Dan expressed concern when Dr. Ross is not available on weekends and unable to review when these types of cases appear - would it be a good idea to develop policy/protocol?
Dr. Ross said we need to set threshold of what high dose opioid means. Use that threshold and when order is submitted, pharmacy can then and information conveyed to pain service anesthesiologist. Getting the patient’s prescription history is key factor. / Dr. Ross/Pharmacy will work together to determine dose that will set trigger mechanism for automatic referral to pain service. Oncology patients are different population; how will we distinguish? It was decided that surgical patients would be more appropriate for this trigger. Before next meeting, devise a plan for presentation. Dr. Ross will take to Anesthesia Section and discuss threshold. / Dr. Ross/Pharmacy
Status of opioid handouts to docs / Handouts clearly define use of 1 mg Dilaudid – how are we getting these to physicians? / Dan will put a stack in surgeons lounge and Alison will put on each floor. / Dan Chatelain/Alison Schlang
New Business:
Patient case review
C. Chapman / Case Review
Valid question is “is there any situation where it’s valid to administer 2 mg Dilaudid?” Dr. Ross feels the answer is no, and believes we can move forward with this belief. Only 1 mg dosage in PYXIS. Dan said best to put these patients on PCAs than to administer boluses. / Test being derived to help non-pain medicine docs in administering meds. Dr. Finn sits on the American Board of Pain Physicians– working on safe opioid guidelines for the non-pain physician.
Dan is going to SFMC on Monday to provide more education to nurses, both safety and multi-modal.
We will not give 2 mg Dilaudid. PCA patients must be on tele-ox (Rose Ann ordered more tele-ox this week).
This committee recommends no dose above 1mg Dilaudid be administered to patient and will be taken to Clinical Effectiveness and PT&D. Dr. Oram-Smith and Alison will work on writing policy. / Dr. Oram-Smith/Alison Schlang
To Clinical Effectiveness and to PT&D
HCAHPS / Will discuss at PRN meeting this month.
Inpatient satisfaction scorecard distributed - 4th, 7th & 9th floors scoring extremely low. Dan & Dr. Ross will track Dr. Matthews’ patients and review their charts as they believe Dr. Matthews is working very hard at multi-modal therapies. Dr. Jepson very interested in the multi-modal therapy as well. Dr. Mann says HCAHPS is also tracked through total joint excellence program. We need to begin there so we don’t duplicate efforts. / Peggy Plylar is key contact for total joint excellence. Make into a simple performance improvement project. Dr. Oram-Smith said objective data is needed as it’s been difficult to demonstrate the benefit of the pain service. / Dan/Dr. Mann/Peggy Plylar
Memorial Pain Conference / Dan announced that he will be teaching at a day-long pain conference at Memorial in May. / Information (Inviting PRN nurses to attend)