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Post-operative Pain ManagementPaula Jarzemsky, Kari Hirvela, Cassie VogeUW Madison School of NursingSpring, 2011

{1Check the EHR . . . Flow SheetsPhysicians OrdersMAR (Medication Administration Record)After viewing all 3, click here to go back to decision #1

8Informatics: navigate an Electronic Health Record (EHR); use high-quality information sources

Patient-centered care: provide compassionate, coordinated care based on respect for patient preferences, values and needs

Evidenced-based practice: locate a relevant clinical practice guideline; discriminate when to modify EBP based on clinical expertise or patient preferences

QSEN CompetenciesIn this module you will learn more about:

3The place . . .

The University of Wisconsin-Madison (UW) Hospital & Clinics

Decision #1 (gather information)After hearing shift report, you decide to:Check the EHR (Electronic Health Record)Talk to a colleagueSee the patientAll the nurses on your unit are really busy right now, so this is not an option right now. What would you like to talk about anyway?Continue scenario . . .7

Chris, RN. You completed a nurse residency program at UW Hospital and now carry your own patient assignment without direct supervision of a preceptor. Today, you will take care of Carmen after her surgery.

Click the icon below to hear the verbal handoff/SBAR (shift-to-shift) report from the AM shift nurse . . .

And you are . . .

6Flow SheetsBack to EHR

Sedation Score11500 VS:

9

Click the below icons (in order) to listen to conversation:You decide to call for an order change:Chris, RNChris, RNDr. SakeiDr. Sakei

14Decision #2 Now that a range order is available (2-6 mg Morphine IV every 2 hours PRN), you need to decide how much to give within this range. Keep in mind it is 3:30 pm and Carmen received 2 mg of IV morphine at 2:30 pm.1 mg2 mg3 mg6 mg

15Decision #4It is 1645. You respond to Carmens call light and she has a pain rating of 8/10. What dose should you give and why:0 mg:

Tell Carmen she needs to wait until 1730 for her next dose.2 mg:

This dose provided minimal side effects.3 mg:

This dose provided best pain relief with manageable side effects.Try again. A pain rating of 8/10 needs intervention.Try again.This dose was ineffective previously.Best choice, nice job!

Can we have a clock in R corner of slide?24Always assess your patientKnow how to access your facilitys pain algorithm and resources.Consider cultural perspectives and involve the patient and family as much as possible in clinical decisions.Understand the importance of integrating EB guidelines (pain algorithm, etc.) into your practice.Click on the icons for other resources related to this scenario:Key PointsPain Algorithm (UWHC)Pain Management Reference (UWHC)Cultural Aspects of Pain Management (UWHC)

Click page down to view references.26ReferencesYou have completed the Post-Operative Pain Management Module.Gordon, D. & Pellino, T. (2005). Incidence and characteristics of Naloxone use in postoperative pain management. Pain Management Nursing 6 (1), pp. 30-36.

Gordon, D.B., Dahl, J., Phillips, P., Frandsen, J., Cowley, C., Foster, R.L., Fine, P.G., Miaskowski, C., Fishman, S., & Finley, R.S. (2004). The use of as-needed range orders for opioid analgesics in the management of acute pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Pain Management Nursing, 5(2), 53-58.

Pasero, C., Manwarren, R. & McCaffrey, M. (2007). IV opioid range orders for acute pain management. American Journal of Nursing 107 (2), 52-60.

Pasero,C., Portenoy, R.K., & McCaffery, M. (1999). Opioid analgesics. In M. McCaffery & Pasero (Eds.), Pain: clinical manual 2nd ed (pp. 161-299). St. Lous: Mosby.

Cultural Aspects of Pain Fast Fact - http://www.eperc.mcw.edu/fastFact/ff_78.htm and University of Wisconsin Hospital and Clinics (Madison, WI)

Respiratory Depression from Opioids Fast Fact University of Wisconsin Hospital and Clinics (Madison, WI)

Pain Algorithm University of Wisconsin Hospital and Clinics (Madison, WI), adapted from Memorial Sloan-Kettering (New York, NY)

Pain Management Reference University of Wisconsin Hospital and Clinics (Madison, WI)

Sedation Assessment Scale - University of Wisconsin Hospital and Clinics (Madison, WI)

Images of Carmen, EHR, MAR modified and used with permission from Elsevier SLS system.

All other images & audio clips from ClipArt within PowerPoint software application27