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Pain Management

Pain Management

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Pain Management

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  1. Pain Management

  2. Patient Controlled Oral Analgesia at Home (PCOAH) Dr Jeremy D Stevens Consultant Anaesthetist Wairau Hospital Blenheim

  3. Introduction • AUDIT CYCLE (revision) • Problem identified • Audit of current practice & literature review • Analyse & discuss need for change • Institute change of practice • Re-audit & review • Repeat as necessary • The project/audit – ‘Pain and Emesis experiences at home after day surgery for 48 hours’ (UK) • Poster • Publication • PHO web-site

  4. The UK Project • Problems highlighted – early 1996 * • Multidisciplinary approach * • Audit of current practice – late 1996 • Standardised questionnaire (article) • Literature review – international • No standards • Change of practice – early 1997 • Re-audit – late 1997 • Presentations – 1998 • Publications – 1999

  5. UK – Change of Practice • Simplify / standardise • Evidence based / balanced analgesia • Pack design 1 & 2 • Information and self administration leaflet • Decision: ‘Which pack type?’ (NSAID sensitivity) • Prescribing simplified: Pack 1 or 2 • Administration by day care nurses prior to discharge • ‘Free’ to the patient; part of contract for the operation • 5 day supply

  6. NZ Project (so far) • Same issues raised – late 2007 • UK tool applied for audit – 2008/2009 • Multidisciplinary team working model

  7. RESULTS

  8. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMERESPONSE & SAMPLE CHARACTERISTICS

  9. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENTS IN MODERATE OR SEVERE PAIN

  10. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC CONSUMPTION & EFFECTIVENESS (1)

  11. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC CONSUMPTION & EFFECTIVENESS (2)

  12. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC EFFECTIVENESS

  13. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT OUTCOMES (1)

  14. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT OUTCOMES (2)

  15. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT SATISFACTION(NZ Audit Only)

  16. Results Summary • Better response • Older ages • Less moderate – severe pain – Consultant service? • Less analgesics supplied • Initial operation day less taken • Less total relief on first day post-op • More sleep disturbance second day post-op • Intermediate information supplied • Overall more contact post-op > 30% pain • Good contact details supplied/functional • Good patient satisfaction

  17. Questions • Is change warranted? Is there a problem? • If change in practice – what? • Similar to UK model? • NZ design? • Multidisciplinary approach? – DEFINITELY • COLLABORATIVE FEEDBACK REQUIRED • Contact - jeremy.stevens@nmdhb.govt.nz