OR Manager - February 2019 - 17

Patient safety
Continued from page 15
" This could include your use of the Pasero
Scale, capnography findings, drug
use evaluation, audits for recognition
of high-risk patients, and monitoring of
reversal agent use, " he says.
EP 7 (D): The hospital reassesses
and responds to the patient's pain
through:
* Evaluation and documentation of response
to pain interventions.
* Progress toward pain management
goals, including functional ability to
take a deep breath, turn in bed, walk
with improved pain control.
* Side effects of treatment.
* Risk factors for adverse events
caused by the treatment.
This EP includes a " D " for documentation,
which in this case refers to documentation
in the medical record; it's not
a policy and procedure, Rosing says.
" It means the surveyors want to
see if the hospital reassesses and responds
to the patient's pain via evaluation
and documentation of response
to pain interventions in the hospital record, "
he explains.
EP 8 (D): The hospital educates the
patient and family on discharge plans
regarding pain management, including:
* Pain management plan of care.
* Side effects of pain management
treatment.
* Activities of daily living, including the
home environment, which might exacerbate
pain or reduce effectiveness
of the pain management plan
of care, as well as strategies to address
these issues.
* Safe use, storage, and disposal of
opioids when prescribed.
" We have not seen a lot of scoring
on this Provision of Care standard yet, "
notes Rosing. " When heavy scoring begins,
it will probably be on the " D " EPs
1, 4, 7, and 8 because on tracer, the
surveyors can ask for you to show them
your documentation. If you don't have it,
you will be scored. "
16
OR Manager | February 2019
Additions to Performance
Improvement standard
Two EPs were added to the 17 EPs of
Performance Improvement standard,
" PI.02.01.01: The hospital compiles
and analyzes data. "
EP 18: The hospital analyzes data
collected on pain assessment and pain
management to identify areas that need
change to increase safety and quality
for patients. Rosing advises picking
clinically relevant measures, such as
identification of high-risk patients, appropriate
use of capnography, and lower
dosing for high-risk patients to comply
with this EP.
EP 19: The hospital monitors the
use of opioids to determine if they are
being used safely, for example, the
tracking of adverse events such as respiratory
depression, naloxone use,
and the duration and dose of opioid
prescriptions.
This is aimed at getting " a handle "
on ordering patterns for inpatients
and outpatients, says Rosing. He suggested
creating a chart of what the
orthopedic surgeons, for example, are
ordering for inpatients postoperatively
and at the time of discharge, revealing
the norm within the group as well as
showing the outliers.
" Over time physicians typically accept
the norm and follow the evidencebased
guidelines, " he says. Any persistent
noncompliance can be taken
up the chain to a department chair or
higher to convince them to get in line.
He also noted that if outpatient prescriptions
are being ordered though the
hospital's computer system, that data
can be mined and used to monitor duration
of outpatient opioid use.
Practical steps to take now
It is important to sharpen pre-existing
opioid use disorder assessment processes.
When a patient is a user, clinicians
should consider a plan to taper
opioids before surgery. Intraoperatively
and immediately postoperatively, there
is an emerging process of multimodal
pain management, which includes regional
anesthesia, IV ketorolac, and IV
acetaminophen.
Postoperative pain management
also can include massage, acupuncture,
guided imagery, heat or cold
therapy, music therapy, and aroma
therapy, as well as past processes of
repositioning, ice pack, conversation,
and hand holding.
" Most important, we have to set
realistic expectations for patients and
their families, " says Rosing. " This is
a big challenge given where we have
been and what these new standards
are going to require. " ✥
-Judith M. Mathias, MA, RN
References
Centers for Medicare & Medicaid
Services. Survey and Certification
Letter. March 14, 2014. https://
www.cms.gov/Medicare/ProviderEnrollment-and-Certification/SurveyCertificationGenInfo/Downloads/
Survey-and-Cert-Letter-14-15.pdf.
Joint
Commission. The Joint Commission
Perspectives. July 2018.
https://www.jointcommission.org/
assets/1/18/Joint_Commission_
Enhances_Pain_Assessment_and_
Management_Requirements_for_Accredited_Hospitals1.PDF.
Rosing
J R. Confronting the opioid
crisis head on: New TJC and CMS
pain standards. OR Manager Conference
2018.
Related Content
For more on this topic, see these OR
Manager articles:
* OR leaders feel the pain of the
opioid crisis (May 2018; 1, 13-16)
* Opioid prescriptions drop after
orthopedic team changes protocol
(June 2018; 15-17)
* Evidence-based practice supports
adopting ERAS protocols
(May 2017; 15-19)
www.ormanager.com

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OR Manager - February 2019

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