Pain Management in the Critically ill Patient
|
|
- Gabriella Fields
- 8 years ago
- Views:
Transcription
1 Pain Management in the Critically ill Patient Jim Ducharme MD CM, FRCP President-Elect, IFEM Clinical Professor of Medicine, McMaster University Adjunct Professor of Family Medicine, Queens University
2 Learning points Recognize pain in the patient unable to respond, but Assume that the critically ill patient will suffer from severe pain Include pain care in your initial resuscitation algorithm Treatment modalities
3 You are intubating someone with acute respiratory failure. Did you consider how much the act of intubation (and subsequent ventilation) will be painful? Have they received any analgesia? Will they?
4 And what are the chances you thought even less about pain management in your stressful resuscitation period of this patient?
5 You would think we would treat this patient s pain automatically but we don t His BP is 70/50, pulse 120. He has 2 open femur fractures and a crush fracture of L2 Priorities: -resuscitate (ABC) -reduce and stabilize fractures -get him into the hands of a surgeon
6 In none of these patients will a pain scale be of value, so how do you know if they are in pain?
7 How have we done in the past? AJEM 2008;26: Inadequate pain relief post intubation IN ED 62/117 received NO analgesic 23 received no analgesia or sedation 67/70 who were paralyzed after intubation received no or inadequate analgesia or sedation
8 It has been no better in the ICU AM J Crit Care 2014;23: In ICU 14 restrained and ventilated patients interviewed: Lack of memory of being restrained Being intubated was horrific Sedation masked uncontrolled pain and prevented patients from telling nurses of their pain
9 Crit Care Resusuc 2013;15: patients in 41 ICUs Pain assessment done in only 46% of patients in 4 hours prior to study observation 16% had moderate pain, 6% severe pain none had received an analgesic Only 42% had sedation titrated to a target level
10 Flail Chest Injuries J Trauma Acute Care Surg 2014;76: From a Canadian national trauma data bank 8% received aggressive pain management (epidural catheters) despite 59% requiring ventilation
11 . Moving forward to 2016 Nurs Clin North Am Mar;51(1): Pain and Agitation Management in Critically Ill Patients Recommendations: Assess regularly, using a validated behavioural tool (RASS, SAS) Minimize sedation to only control agitation Treat pain more, sedate less
12 A first step towards safer sedation and analgesia: A systematic evaluation of outcomes and level of sedation and analgesia in the mechanically ventilated critically ill patient. Jan 2016 Sedation monitored using the Richmond agitation-sedation scale Analgesia effect measured using the numeric rating scale, or behavioural indicators of pain scale Standardized approach on all patients
13 Still not easy however it is a permanent challenge for nurses to discriminate situations requiring sedation from situations requiring analgesia Aust Crit Care Feb;28(1):2-8 Necessary assumption: in agitated patients or in those with increased BP and pulse, these changes are due to pain
14 Ger Med Sci Nov 12;13:Doc19. doi: / Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine
15 Why have emergency departments not taken similar steps? STANDARDIZED PAIN ASSESSMENT AND MANAGEMENT IN ALL CRITICALLY ILL PATIENTS
16 Failure to manage pain has consequences Longer duration of mechanical ventilation Longer ICU length of stay Open Cardiovasc Med J Jun 26;9:91-5
17 . Biomed Res Int. 2015;2015: doi: /2015/ The Impact of Pain Assessment on Critically Ill Patients' Outcomes: A Systematic Review Favorable effects on: pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, complications
18 Failure to control pain: the long term consequence of short term failure J Pain Research 2013;6: USA study of 100 post trauma/post surgery patients with neuropathic pain 82 taking 2 or more pain meds Annualized indirect costs: $29,617, with direct costs of $11,846 Interference in Function Sleep Depression Health utility
19 Known for 15 years: trauma pain and PTSD Biol Psychiatry 2009;65: patients admitted for trauma 17 met PTSD criteria at 3 months These patients received significantly less morphine and had greater pain scores during their hospitalization J Am Acad Child Adolesc Psych 2001;40: Children aged 6-16 with burns requiring admission Significant association between the dose of morphine received in hospital and a 6 month reduction in PTSD symptoms. Similar finding reproduced in 2009 for children aged 1-4 years.
20 Some other myths Crit Care Med 2015; 43: Accurate pain assessment cannot be performed in critically ill patients because pain is subjective Opioids are all that is needed for effective pain control Sedation is the same as analgesia when in fact sedation results in worse pain management
21 Baseline and protocolized steps TREATMENT MODALITIES FOR PAIN
22 Establish protocols for regional anesthesia in trauma patients Fractures of femurs or hips U/S guided femoral nerve blocks Epidurals or intercostal nerve blocks for flail chest
23 No intubated patient should leave the ED without an infusion of some analgesic Fentanyl 3 mcg/kg 3-5 minutes prior to intubation mcg/kg/hr Ketamine mg/kg/hr No patient should be intubated without analgesia!
24 No intubated patient should undergo a painful procedure without prior analgesia Suctioning Major line placement Re-positioning a trauma patient Fracture reduction and casting Burn management Etc
25 Sedation is rarely the better answer Sedating does not provide pain relief. Rather it masks it. Treat pain first: only then identify if sedation is required (usually much less) Being intubated was horrific due to uncontrolled pain Easy to forget in such a complex system
26 Summary Pain management should be an integral part of our care It needs to be included in every algorithm for our sickest and most injured patients as it is too easy to overlook EVERY critically ill patient will suffer pain
27 Thank you! Time for any questions An amazing city, an even better conference!
WITHDRAWAL OF ANALGESIA AND SEDATION
WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening drug doses
More informationDRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement
Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,
More information*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.
Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational
More informationObjectives. Important Principles
Management of the Intubated Patient Christopher J. Edwards, PharmD, BCPS Clinical Pharmacist - Emergency Medicine March 19 th, 2013 REPS EC SAG 2 Objectives Describe the rationale for post intubation analgesia
More informationAcute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC
Acute Pain Management in the Opioid Dependent Patient Maripat Welz-Bosna MSN, CRNP-BC Relieving Pain in America (IOM) More then 116 Million Americans have pain the persists for weeks to years $560-635
More information9/16/2010. Contact Information. Objectives. Analgesic Ketamine (Ketalar )
Analgesic Ketamine (Ketalar )..the long and winding road to clinical practice Contact Information Lois Pizzi BSN, RN-BC Inpatient Pain Management Clinician UPMC Presbyterian Shadyside pizzilj@upmc.edu
More informationVA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 118-28 SAN DIEGO, CA
GUIDELINES FOR PATIENT-CONTROLLED ANALGESIA (PCA) AND PATIENT- CONTROLLED EPIDURAL ANALGESIA (PCEA) FOR ACUTE PAIN MANAGEMENT 1. PURPOSE: To assure the safe and effective use of patient controlled analgesia
More information4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal
Background 1 Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Alyssa Cavanaugh, PharmD PGY1 Pharmacy Resident Children s Hospital of Michigan **The speaker has no actual or
More informationTargeting patients for use of dexmedetomidine
Targeting patients for use of dexmedetomidine H a n n a h W u n s c h, M D M S c H e r b e r t I r v i n g A s s i s t a n t P r o f e s s o r o f A n e s t h e s i o l o g y & E p i d e m i o l o g y
More informationCH CONSCIOUS SEDATION
Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision
More informationPhenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy
Phenobarbital in Severe Alcohol Withdrawal Syndrome Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Disclosure: No relevant financial relationship exists. Objectives 1. Describe the pathophysiology
More informationHuman Capital Development & Education Program Proposal
Human Capital Development & Education Program Proposal Cardiology & Cardiovascular Surgery Emergency Medicine Respiratory Medicine Infection Control HMIS 1 (15 Courses) Module 1/2 1/15 Course Title : Management
More informationPROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice
PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice P.O. BOX 2129 Raleigh, NC 27602 (919) 782-3211 FAX (919) 781-9461 Nurse Aide II Registry (919) 782-7499 www.ncbon.com Issue: Administration
More informationThe Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson
The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson As a private practice anesthesiologist, I am often asked: What are the potential benefits of regional anesthesia (RA)? My
More informationPalliative Medicine, Pain Management, and Hospice. Devon Neale, MD Assistant Professor Dept of Internal Medicine UNM School of Medicine
Palliative Medicine, Pain Management, and Hospice Devon Neale, MD Assistant Professor Dept of Internal Medicine UNM School of Medicine Pall-i- What??? Objectives: Provide information about Palliative Medicine
More informationReview of Pharmacological Pain Management
Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization
More informationA Patient s Guide to PAIN MANAGEMENT. After Surgery
A Patient s Guide to PAIN MANAGEMENT After Surgery C o m p a s s i o n a n d C o m m i t m e n t A Patient s Guide to Pain Management After Surgery If you re facing an upcoming surgery, it s natural to
More informationDocumentation Guidelines for Physicians Interventional Pain Services
Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record
More informationSutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL
Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL Delirium-(acute brain dysfunction) is defined as a disturbance of consciousness with inattention accompanied by a change in cognition or
More informationAcute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction
Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction June 9, 2011 Tufts Health Care Institute Program on Opioid Risk Management Daniel
More informationDegree of Intervention
Inglewood Care Centre Degree of Intervention Handbook for Residents and Families Index Introduction..................................................... 2 Beliefs, Values, and Wishes.........................................
More informationCancer Pain. Relief from PALLIATIVE CARE
PALLIATIVE CARE Relief from Cancer Pain National Clinical Programme for Palliative Care For more information on the National Clinical Programme for Palliative Care, go to www.hse.ie/palliativecareprogramme
More informationPHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false.
PHSW Procedural Sedation Post-Test Answer Key 1 1. Define Procedural (Conscious) Sedation: A medically controlled state of depressed consciousness where the patient retains the ability to continuously
More informationTRANSPORT OF CRITICALLY ILL PATIENTS
TRANSPORT OF CRITICALLY ILL PATIENTS Introduction Inter-hospital and intra-hospital transport of critically ill patients places the patient at risk of adverse events and increased morbidity and mortality.
More informationNURSING SERVICES DEPARTMENT
NURSING SERVICES DEPARTMENT TITLE: Mechanical Ventilation PATIENT CARE PLAN DIAGNOSIS: DISCHARGE CRITERIA: 1 The patient will: Maintain adequate mechanics of PERTINENT INFORMATION:. ventilation as demonstrated
More informationCollaborative Practice Agreement for Nurse Practitioner Management of Patients in the Specialty of Pediatric Critical Care
Collaborative Practice Agreement for Nurse Practitioner Management of Patients in the Specialty of Pediatric Critical Care Purpose Section I Introduction/Overview This document authorizes the nurse practitioner
More informationPain Management for Labour & Delivery
Pain Management for Labour & Delivery Departments of Anesthesia, Obstetrics, and Obstetrical Nursing December 2008 This pamphlet has been prepared to provide you, members of your family, and others who
More informationRuchika D. Husa, MD, MS Assistant t Professor of Medicine in the Division of Cardiology The Ohio State University Wexner Medical Center
Modified Early Warning Score (MEWS) Ruchika D. Husa, MD, MS Assistant t Professor of Medicine i in the Division of Cardiology The Ohio State University Wexner Medical Center MEWS Simple physiological scoring
More informationHow To Improve Care For Bronchiolitis
Implementation of an Evidence- Based Care Guideline for Inpatient Bronchiolitis Management J E A N E T T E J O N E S, R N + T H O M A S M A Y E S, M D, M B A * + M A R I S S A M A R T I N E Z, M D + S
More informationAlways present... A Nurse Anesthetist Leaflet. The Norwegian Nurses Association and the Norwegian Association of Nurse Anesthetists
Always present... A Nurse Anesthetist Leaflet The Norwegian Nurses Association and the Norwegian Association of Nurse Anesthetists A brief history Nurses started giving general anesthetics to patients
More informationTest Content Outline Effective Date: June 9, 2014. Pain Management Nursing Board Certification Examination
Pain Management Nursing Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are pretest questions that are not scored. Pretest questions
More informationMichael Brennan, MA, LMHC Providence St. Peter Hospital Crisis Services
Michael Brennan, MA, LMHC Providence St. Peter Hospital Crisis Services Welcome to the E.R.: Emergency: noun Webster 1. a sudden, urgent, usually unexpected occurrence or occasion requiring immediate action.
More informationChallenges of Pain Management In the Emergency Department
Challenges of Pain Management In the Emergency Department Joe Johnsey MD FACEP Medical Director Emergency Services North Mississippi Medical Center Disclosures THE END Objectives So what is the issue?
More informationRecommendations for Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages
Recommendations for Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages Gail Gesin, PharmD* Clinical Phramacist for Trauma Critical Care Carolinas Medical Center Charlotte, North
More informationObjectives. Pain Management Knowing How To Help Yourself. Patients and Family Requirements. Your Rights As A Consumer
Objectives Pain Management Knowing How To Help Yourself Jackie Carter, RN MSN CNS Become familiar with the definitions of pain Be aware of your rights to have your pain treated Become familiar with the
More informationSpinal cord stimulation
Spinal cord stimulation This leaflet aims to answer your questions about having spinal cord stimulation. It explains the benefits, risks and alternatives, as well as what you can expect when you come to
More informationThe Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy
The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting
More informationGuidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling
Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate
More informationAnesthesia Guidelines
Anesthesia Guidelines Updated April 2012 Anesthesia BlueCross requires anesthesiologists and certified registered nurse anesthetists (CRNAs) to file claims using CPT anesthesia codes. We cover general
More informationPain Assessment and Management in Critically
Pain Assessment and Management in Critically Louise Rose Lawrence S. Bloomberg Professor in Critical Care Nursing, University of Toronto Adjunct Scientist, Mt Sinai Hospital and Li Ka Shing Institute,
More informationReducing harm from high-alert medications
Institute for Healthcare Improvement s 5 Million Lives Campaign Best-practice protocols: Reducing harm from high-alert medications The Institute for Healthcare Improvement challenges clinicians and administrators
More informationTransitioning Chronic Pain Patients Out of the Hospital. Rosemary Quirk, MD, DTMH ACP, November 7, 2014
Transitioning Chronic Pain Patients Out of the Hospital Rosemary Quirk, MD, DTMH ACP, November 7, 2014 Patients rate baseline chronic pain between 4/10-8/10 on clinic surveys This fact should fundamentally
More informationQuality and Safety Programme Fractured neck of femur services
Quality and Safety Programme Fractured neck of femur services London quality standards February 2013 1 Introduction The case for change for fractured neck of femur services in London demonstrates that
More informationWeaning off your pain medicine
Weaning off your pain medicine UHN Information for patients taking opioid pain medicines Read this booklet to learn about: why you need to wean off your pain medicine how to wean off slowly how to control
More informationIACUC Guideline LARGE ANIMAL FORMULARY
The intention behind the development of a University of Pennsylvania IACUC-endorsed drug formulary for the larger species used in biomedical research was to provide guidance for anesthetic and analgesic
More informationOutline. Advanced Practice Providers in the Intensive Care Unit. Why utilize APPs in the ICU? 5/30/2013
Outline Advanced Practice Providers in the Intensive Care Unit Thomas Farley MS, NP Assistant Clinical Professor UCSF School of Nursing Why utilize APPs in the ICU Recent publications General review of
More informationOctober 2012. We hope that our tool will be a useful aid in your efforts to improve pain management in your setting. Sincerely,
October 2012 he Knowledge and Attitudes Survey Regarding Pain tool can be used to assess nurses and other professionals in your setting and as a pre and post test evaluation measure for educational programs.
More informationGuidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists
Guidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists Copyright 2005 222 South Prospect Park Ridge, IL 60068 www.aana.com Guidelines for Core Clinical Privileges Certified Registered
More informationPOST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics
POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped
More informationBOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 info@bpsweb.org www.bpsweb.
BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 info@bpsweb.org www.bpsweb.org Content Outline for the CRITICAL PHARMACY SPECIALTY CERTIFICATION
More informationYour anaesthetist may suggest that you have a spinal or epidural injection. These
Risks associated with your anaesthetic Section 11: Nerve damage associated with a spinal or epidural injection Your anaesthetist may suggest that you have a spinal or epidural injection. These injections
More informationGENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS
Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION
More informationWhy are QI methods needed?
Quality Improvement for ICU Rehab, Sedation & Delirium Why are QI methods needed? Dale M. Needham, MD, PhD Professor, Pulmonary & Critical Care, and Physical Med & Rehab Dale.Needham@jhmi.edu @DrDaleNeedham
More informationProgram Specification for Master Degree Anesthesia, ICU and Pain Management
Cairo University Faculty of Medicine Program type: Single Program Specification for Master Degree Anesthesia, ICU and Pain Management Department offering program: Anesthesia, intensive care and pain management
More informationThe American Society of Anesthesiologists (ASA) has defined MAC as:
Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic
More informationOpioid toxicity and alternative opioids. Palliative care fixed resource session
Opioid toxicity and alternative opioids Palliative care fixed resource session Opioid toxicity and alternative opioids - aims Know the symptoms of opioid toxicity Understand which patients are at higher
More informationTitle/Subject Procedural Sedation and Analgesia Page 1 of 10
Policy Procedural Sedation and Analgesia Page 1 of 10 Scope: Providers and nurses (M.D., D.O., D.M.D., D.D.S., A.P.R.N., P.A., R.N.) with appropriate privileges and who have successfully demonstrated adequate
More informationin the Elderly Thomas Robinson, MD Surgery Grand Rounds March 10 th, 2008
Post- Operative Delirium in the Elderly Thomas Robinson, MD Surgery Grand Rounds March 10 th, 2008 What is the most common post-operative complication in elderly patients? What is the most common post-operative
More informationYour spinal Anaesthetic
Your spinal Anaesthetic Information for patients Your spinal anaesthetic This information leaflet explains what to expect when you have an operation with a spinal anaesthetic. It has been written by patients,
More informationUniversity of Michigan Alcohol Withdrawal Guidelines Overview
University of Michigan Alcohol Withdrawal Guidelines Overview The following document contains the University of Michigan Alcohol Withdrawal Guidelines. These guidelines were developed through an intensive
More informationPerioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine
Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley
More informationAbstract. contributed to this achievement include advances in body armor, availability
The Role of Pain Management in Recovery Following Trauma and Orthopaedic Surgery COL Chester C. Buckenmaier III, MD, MC, USA Abstract War often serves as a catalyst for medical innovation and progressive
More informationCorporate Medical Policy
File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main
More informationThe MOD Experience after 1,000 Patients
The MOD Experience after 1,000 Patients Sharon Conley MD PhD CPE, Chief Medical Officer, Avancen MOD Corporation Summary This paper reports the results of a survey from three hospitals and a skilled nursing
More informationManaging canine osteoarthritis: What has proven benefits?
Managing canine osteoarthritis: What has proven benefits? B. Duncan X. Lascelles and Denis J. Marcellin-Little North Carolina State University Student Chapter of the IVAPM, Durham, NC 10.10.2006 Osteoarthritis:
More informationSUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]
SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual
More informationHealthcare Inspection. Quality of Care Concerns Hospice/Palliative Care Program VA Western New York Healthcare System Buffalo, New York
Department of Veterans Affairs Office of Inspector General Office of Healthcare Inspections Report No. 13-04195-180 Healthcare Inspection Quality of Care Concerns Hospice/Palliative Care Program VA Western
More informationEpidural Continuous Infusion. Patient information Leaflet
Epidural Continuous Infusion Patient information Leaflet April 2015 Introduction You may already know that epidural s are often used to treat pain during childbirth. This same technique can also used as
More informationSARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: MANAGEMENT OF THE PREGNANT PATIENT WITH EPIDURAL ANESTHESIA POLICY #: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: PAGE: 126.722 (maternal) 10/88
More informationINTERSCALENE BLOCK AND OTHER ARTICLES ON ANESTHESIA FOR ARTHROSCOPIC SURGERY NOT QUALIFYING AS EVIDENCE
INTERSCALENE BLOCK AND OTHER ARTICLES ON ANESTHESIA FOR ARTHROSCOPIC SURGERY NOT QUALIFYING AS EVIDENCE Hughes MS, Matava MJ, et al. Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery.
More informationQuality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased.
Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased. This graph shows the percent of residents whose need for help doing basic daily tasks
More informationQuality Improvement Project Enhanced Recovery and Rehabilitation for Fracture Neck of Femur
Quality Improvement Project Enhanced Recovery and Rehabilitation for Fracture Neck of Femur Borders General Hospital Implementing Enhanced Recovery in Process Outcomes Food for thought Orthopaedics Summarise
More informationClinical Audit: Prescribing antipsychotic medication for people with dementia
Clinical Audit: Prescribing antipsychotic medication for people with dementia Trust, team and patient information Q1. Patient's DIS number... Q2. Patient s residence: Home Residential Home Nursing Home
More informationPlace hospital logo here
Place hospital logo here Nurse-Driven Protocol for the Management of Patients in Alcohol/Substance Withdrawal Maimonides Medical Center (MMC) Sharon Hawthorne, RN, BSN, CCRN, SSN II Ariadne Williams, RN,
More informationThe College of Emergency Medicine. Best Practice Guideline. Management of Pain in Children. Management of pain in children (REV July 2013) 1
The College of Emergency Medicine Best Practice Guideline Management of Pain in Children Management of pain in children (REV July 2013) 1 Revised July 2013 Management of pain in children (REV July 2013)
More informationMedical Coverage Policy Monitored Anesthesia Care (MAC)
Medical Coverage Policy Monitored Anesthesia Care (MAC) Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2004 Policy Last Updated: 1/8/2013 Prospective review is recommended/required.
More informationENHANCEMENT OF ACUTE SERVICE IN KCC ON CLINICAL PATHWAY FOR GERIATRIC HIP FRACTURE. Elaine Wong WY Queen Elizabeth Hospital 7 May 2012
ENHANCEMENT OF ACUTE SERVICE IN KCC ON CLINICAL PATHWAY FOR GERIATRIC HIP FRACTURE Elaine Wong WY Queen Elizabeth Hospital 7 May 2012 BACKGROUND In KCC, there are around 800 cases admitted for geriatric
More informationEquine Sedation, Anesthesia and Analgesia
Equine Sedation, Anesthesia and Analgesia Janyce Seahorn, DACVAA, DACVIM-LA, DACVECC Lexington Equine Surgery and Sports Medicine Equine Veterinary Specialists Georgetown, KY The need for equine field
More informationEarly Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi
Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the
More informationPalmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM
Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM Attorney General s Prescription Drug Abuse Task Force Member AIT Laboratories Advisory Board In 2009, 44%
More informationPARAMEDIC TRAINING CLINICAL OBJECTIVES
Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members
More informationDeciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health
Deciding About Health Care A GUIDE FOR PATIENTS AND FAMILIES New York State Department of Health 1 A GUIDE FOR PATIENTS AND FAMILIES Introduction Who should read this guide? This guide is for New York
More informationThe Difficult to Sedate ICU Patient
The Difficult to Sedate ICU Patient Dan Burkhardt, M.D. Associate Professor Department of Anesthesia and Perioperative Care University of California San Francisco burkhard@anesthesia.ucsf.edu Richmond
More informationClinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients
Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Developed by the Mid Atlantic Renal Coalition and the Kidney End of Life Coalition September 2009 This project was supported,
More informationPain Management after Surgery Patient Information Booklet
Pain Management after Surgery Patient Information Booklet PATS 509-15-05 Your Health Care Be Involved Be involved in your healthcare. Speak up if you have questions or concerns about your care. Tell a
More informationThe most important room in the hospital : that s
ECRI Institute Perspectives Postanesthesia care action plan aims to ensure optimal patient safety The most important room in the hospital : that s what a landmark 1969 case in Canada Laidlaw v. Lions Gate
More informationChapter 7. Ideally, educational preparation for childbirth begins prior to conception
Chapter 7 Nursing Management of Pain During Labor and Birth Key Terms Cleansing breath Effleurage Endorphins Pain threshold Focal point Pain tolerance Education for Childbearing Ideally, educational preparation
More informationLevels of Critical Care for Adult Patients
LEVELS OF CARE 1 Levels of Critical Care for Adult Patients STANDARDS AND GUIDELINES LEVELS OF CARE 2 Intensive Care Society 2009 All rights reserved. No reproduction, copy or transmission of this publication
More informationRehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary
Rehabilitation within critical care By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Contents Negative effects of Critical illness/ prolonged ventilation Evidence
More informationEnd of Life Care in ICU: Online Support for Nurses
End of Life Care in ICU: Online Support for Nurses Brenda Hearson RN, MN, CHPCN(C), CNS Janice Nesbitt, RN, MN, CHPCN(C), CNS CACCN Conference September 26, 2015 Statement of Disclosure and Bias We have
More informationEvaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients
Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential
More informationWhy does delirium develop?
What is delirium? Delirium is a name for acute confusion. The patient who is delirious is often experiencing a world that makes no sense to us but is very real to them. For instance they may: not know
More informationMedical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015
Medical marijuana for pain and anxiety: A primer for methadone physicians Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Conflict of interest statement No conflict of interest to
More informationLife Care Plan vs. Medical Cost Projection: Claims Management Tools
Life Care Plan vs. Medical Cost Projection: Claims Management Tools Nurse Case Manager Life Care Planner Lynn works for: Stubbe & Associates Miller Park Crain Accident Life Care Plans What is a life care
More informationSpinal Cord Stimulation (SCS) Therapy: Fact Sheet
Spinal Cord Stimulation (SCS) Therapy: Fact Sheet What is SCS Therapy? Spinal cord stimulation (SCS) may be a life-changing 1 surgical option for patients to control their chronic neuropathic pain and
More informationEMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.
M07 Medications 2015-07-15 All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam
More informationBorderline personality disorder
Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases
More informationOpioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist
Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids
More informationdevoted physicians. collaborative partners. metrics-driven quality.
Regional Anesthesia and Multimodal Pain Management Improves Outcomes, Reduces Costs and Boosts Patient Satisfaction devoted physicians. collaborative partners. metrics-driven quality. usap.com jlrmedicalgroup.com
More informationCollaboration Anesthesia
HPC hpcconnection.ca Nursing Neuro - axial Analgesia cross sector Pharmacists Intractable patient centered Opioids Interventional Consensus Collaboration Anesthesia Physicians epidural evidence based Intraspinal
More information