SE1EO-18Pain CommitteeFriday, September 7,, 2012Penrose Board Room

Attendance: Drs. Oram-Smith, Ross, Finn, Mann; Dan Chatelain, Mike Force, Audrey Simpson, Carlos Johnson, Katie Lammi, Rose Ann Moore, Carolyn Cusic, Deb Nussdorfer, Kathy Guy, Charlie Stine, Jeanne Rice

Subject / Discussion / Action / Responsibility
Call to Order / The meeting was called to order at 7:04am
Review of Minutes / The April 2012 minutes were reviewed and approved as submitted (last committee meeting held).
Follow up Items:
Introduction – Katie Lammi, NP / Katie is the new Pain/Palliative Care nurse; will be housed at SFMC. She is working toward prescriptive authority. This represents changes in nurse staffing to meet identified need for expanded clinical expert services at SFMC and is consistent with this committees request. / Katie is currently orienting and will establish office at SFMC by middle of October. Katie will provide ongoing education and mentoring to nurses at SFMC. This is especially critical with our new graduate nurses. / Katie Lammi RN, Kathy Guy RN
Narcan data / Had one Narcan rescue last week – PACU to 11th floor. Float nurse was caring for patient, no sedation level had been done at all. Dan worries that float nurses/agency nurses not trained as well. PSFHS nurses receive orientation and competency monitoring including pain management, sedation monitoring, PCA use. Dan discussed elderly patient with elevated creatinine receiving morphine, risk, and complications.
Rose Ann said nursing audits reflect either practice or documentation deficits with reassessment process following administration of pain management. The Nursing Practice Council (NPC) reviewed practices, obtained recommendations from expert pain nurses in three other organizations, reviewed the literature and made decision to require we wake patients to reassess pain and sedation per policies. For example if we are reassessing morphine effectiveness at one hour we will wake the patient – to improve patient safety. The NPC discussed partnering with patients and informing them of this practice for their safety to reduce potential irritation at being wakened. Article in nursing TLC newsletter. / Do education with float pool nurses.
Support Nursing Practice Council revision to standard of practice. / Dan Chatelain RN
Katie Lammi RN
Nursing Leadership, Pain nurses
Narcan Rescue QI / Deb distributed a graph of Narcan Rescues at Penrose Jan 2008 through July 2012. Actions taken by this council and by the Nursing Practice Council are continuing to reduce iatrogenic over sedation in patients at PH. We have decreased phenergan dosing, revised order sets, educated nursing and physician, provided tip sheets, expanded assessment and monitoring of patients with sleep apnea, created an active pain resource nurse team, quarterly pain newsletter for nurses, identified and implemented new evidence based practices. / Recommend we review pain satisfaction scores for same time frame with critical eye to any decrease in satisfaction scores that may be related to changes in practice to reduce risk of over sedation.
Great results as we note the significant improvement during these last two years!
Plan for expansion to SFMC as Katie takes on leadership role. / Dan Chatelain RN
Katie Lammi RN
PCA Protocols / Dilaudid PCA protocol and morphine PCA protocol are not equal. Dilaudid protocol stops at .4 – morphine protocol is a full mg higher.
Physicians are the ones ordering; Dr. Oram-Smith says need to confront them.
Alison said standard Centura PCA protocol for go-live CPOE. Alison brought copies for Committee to review. Mike says very similar. Dr. Ross feels this looks like very appropriate option. Dr. Oram-Smith said surgeons are used to ordering standard protocol and this gives them several choices. Mike said proposal now is to split into three separate orders; fentanyl, hydromorphone, and ?
Substitute this order set for our protocol. How do we roll out / Dan will do education?
Alison said every hospital using CPOE is using this order set. Dr. Oram-Smith said this order set will be embedded in every post-op order set.
How best to convey this change? PACU sometimes has old order sets – start there. Train unit managers and unit secretaries. Send out information to all who use PCAs. Follow-up next month.
Need to be in totally different places (personal order sets) – these are embedded in Meditech and will be the driver for us. / Kathy Guy