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Navigating Multimodal Analgesia with Hepatic and Renal Insufficiency
Meeting Abstracts well positioned to advocate, assess, intervene and treat patients’ pain; yet many bedside nurses would agree they are ill-prepared to tackle the conundrum of managing pain. Those who are ill-equipped will often avoid or dismiss reports of pain, whether from a lack of basic education preparation, new-orientee mentorship or ongoing continuing educational opportunities. Single educational interventions have proven to be unsuccessful in knowledge retention and practice improvements, with many nurses learning erroneous pain management approaches through indoctrination by seasoned coworkers and non-nurse providers. So how does an organization grow a knowledgeable pain resource professional? Through a partnership between the local college of nursing and the hospital, a course (based on the Wisconsin PRN Curriculum and awarding CEU’s and college credit) and a subsequent education and mentoring program provided expanded knowledge and approaches to assist participants in assuming an active pain management resource role. ‘‘Graduates’’ were then provided one-on-one mentoring, leadership support and monthly meetings to continue to build upon their newly acquired pain management base of knowledge and expand their new role. With the use of qualitative and quantitative data, this presentation will detail the journey of a 300+ bed, level II trauma center in developing and establishing an innovative program to equip point-of-care staff nurses to become Pain Resource Professionals (PRP).
Ketamine: An Increasingly Common Option in the Pain Management Toolbox Michael Urton, MSN, CNS-BC Adult/Gerontology, Clinical Nurse Specialist, Pain, Duke University Hospital Cynthia Klaess, MSN, RN, ACNS-BC, CCM Clinical Nurse Specialist, Pain Team, Duke University Hospital AIM Describe experiences at a large, university medical center regarding the utilization of continuous intravenous ketamine infusions in the management of acute, post-operative and persistent pain conditions in adult and pediatric inpatient populations. A case-study approach will be used to highlight some of the most common contraindications, side effects and prescribing techniques used with ketamine infusions. METHODS Current hospital policies were examined along with the most recent literature related to ketamine infusions for chronic/ persistent pain. The information gathered from these sources was reviewed alongside a number of specific patient cases where ketamine was used to improve pain management outcomes (improved pain rating scores, reduced opioid intake, reduced length of stay) with the goal of assessing current practices and trends in the use of low-dose ketamine infusions. Patients included for discussion and review consisted of a variety of patient types, including patients with sickle-cell crisis, postoperative with history of chronic pain, pediatric oncology, as well as routine postoperative patients not well managed with opioid therapy.
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RESULTS N/A. CONCLUSIONS The current literature related to the effectiveness of continuous low-dose ketamine for pain is inconclusive, but there are significant gaps in the body of evidence. Current studies consist primarily of small, convenience samples resulting in underpowered studies of limited use. Current practice at our facility, and daily observations of patients receiving lowdose ketamine infusions, has shown (anecdotally) improvements in pain satisfaction, reductions in daily opioid use and reduced time to discharge. The incidence of adverse effects with ketamine use has been minimal with none of the patients requiring a transfer to a higher level of care. When compared to use of various opioid modalities (e.g. PCA, oral as needed), ketamine has a much safer risk profile that might increase its use of non-opioid-tolerant patients in the future.
Navigating Multimodal Analgesia with Hepatic and Renal Insufficiency Susan E. Hodgkins, MSN CRNP-BC Pain Management Nurse Practitioner, St. Joseph Medical Center The practice of utilizing multimodal analgesia has become a common practice in pain management. Multimodal analgesia can be a very effective practice if the providers and caregivers are aware of the many variables that must be considered when ordering and dispensing various medications. It doesn’t matter if you are the person dispensing or ordering the medication. A working knowledge of hepatic and renal insufficiency are paramount. This presentation will review the principles of Pharmacokinetics and Pharmacodynamics and the role they play when a patient takes any medication. Hepatic failure and how to recognize it and renal insufficiency and the various stages will be the main focus of this presentation. Various medications will be reviewed, including opioids, NSAIDS, acetaminophen, anticonvulsants and antidepressants, and the indications for these medications in light of hepatic and renal disease. What medications should patients avoid, and which ones are safe? The goal of the this presentation is to increase awareness of renal and hepatic insufficiency and to be mindful of the medications used to treat pain as safely as possible in light of various co-morbidities the patient may have.
Developing a Pediatric RN Administered Nitrous Oxide/ Oxygen Program for a Multi-state Hospital System: Challenges & Lessons Teri Reyburn-Orne, RN-BC, PPCNP-BC, CPNP-AC Pediatric Nurse Practitioner Pain Team Program Manager, Cardon Children’s Medical Center AIM OF INVESTIGATION The use of nitrous oxide/oxygen for anxiolysis has been shown to be a safe and effective in pediatric dentistry in medical settings both outpatient and inpatient. Our goal was to
Ketamine: An Increasingly Common Option in the Pain Management Toolbox Michael Urton, MSN, CNS-BC Adult/Gerontology, Clinical Nurse Specialist, Pain, Duke University Hospital Cynthia Klaess, MSN, RN, ACNS-BC, CCM Clinical Nurse Specialist, Pain Team, Duke University Hospital AIM Describe experiences at a large, university medical center regarding the utilization of continuous intravenous ketamine infusions in the management of acute, post-operative and persistent pain conditions in adult and pediatric inpatient populations. A case-study approach will be used to highlight some of the most common contraindications, side effects and prescribing techniques used with ketamine infusions. METHODS Current hospital policies were examined along with the most recent literature related to ketamine infusions for chronic/ persistent pain. The information gathered from these sources was reviewed alongside a number of specific patient cases where ketamine was used to improve pain management outcomes (improved pain rating scores, reduced opioid intake, reduced length of stay) with the goal of assessing current practices and trends in the use of low-dose ketamine infusions. Patients included for discussion and review consisted of a variety of patient types, including patients with sickle-cell crisis, postoperative with history of chronic pain, pediatric oncology, as well as routine postoperative patients not well managed with opioid therapy.
95
RESULTS N/A. CONCLUSIONS The current literature related to the effectiveness of continuous low-dose ketamine for pain is inconclusive, but there are significant gaps in the body of evidence. Current studies consist primarily of small, convenience samples resulting in underpowered studies of limited use. Current practice at our facility, and daily observations of patients receiving lowdose ketamine infusions, has shown (anecdotally) improvements in pain satisfaction, reductions in daily opioid use and reduced time to discharge. The incidence of adverse effects with ketamine use has been minimal with none of the patients requiring a transfer to a higher level of care. When compared to use of various opioid modalities (e.g. PCA, oral as needed), ketamine has a much safer risk profile that might increase its use of non-opioid-tolerant patients in the future.
Navigating Multimodal Analgesia with Hepatic and Renal Insufficiency Susan E. Hodgkins, MSN CRNP-BC Pain Management Nurse Practitioner, St. Joseph Medical Center The practice of utilizing multimodal analgesia has become a common practice in pain management. Multimodal analgesia can be a very effective practice if the providers and caregivers are aware of the many variables that must be considered when ordering and dispensing various medications. It doesn’t matter if you are the person dispensing or ordering the medication. A working knowledge of hepatic and renal insufficiency are paramount. This presentation will review the principles of Pharmacokinetics and Pharmacodynamics and the role they play when a patient takes any medication. Hepatic failure and how to recognize it and renal insufficiency and the various stages will be the main focus of this presentation. Various medications will be reviewed, including opioids, NSAIDS, acetaminophen, anticonvulsants and antidepressants, and the indications for these medications in light of hepatic and renal disease. What medications should patients avoid, and which ones are safe? The goal of the this presentation is to increase awareness of renal and hepatic insufficiency and to be mindful of the medications used to treat pain as safely as possible in light of various co-morbidities the patient may have.
Developing a Pediatric RN Administered Nitrous Oxide/ Oxygen Program for a Multi-state Hospital System: Challenges & Lessons Teri Reyburn-Orne, RN-BC, PPCNP-BC, CPNP-AC Pediatric Nurse Practitioner Pain Team Program Manager, Cardon Children’s Medical Center AIM OF INVESTIGATION The use of nitrous oxide/oxygen for anxiolysis has been shown to be a safe and effective in pediatric dentistry in medical settings both outpatient and inpatient. Our goal was to