Approved Hospital Formulary
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Approved Hospital Formulary
10/04/18 JR -- Multimodal analgesia in Adults
From: Jerry Robinson Pharm.D.
To: Pharmacists
Sent: Thursday, October 4, 2018 7:25:30 AM
Subject: Multimodal analgesia in Adults
Multimodal analgesia management additions to various order sets have been in place for a couple of weeks. Feedback has been sent to me directly by Mr. Thomas Fender (Surgery VP, provided feedback on neurosurgeon complaints), Dr. Harriman, and Dr. Durst. All other feedback has come from nursing staff at perioperative areas.
Some surgeons have wanted certain things not done, no multimodal analgesia at all, or use only in certain patient populations.
Any surgeon/prescriber has the obvious right to order whatever is appropriate or discontinue anything they see as inappropriate for a particular patient.
However, it is the prescribers responsibility to inform us through orders of what they want to be changed. These changes can be written on a green order sheet for iCare entry, marked out on the original order sets, or noted on the original implementation order set. This is the same process for all types of orders within order sets.
To date, the only order set change request for iCare implementation has been sent in for neurosurgery order sets moving multimodal from a 'numbered' item to a 'check box' item for implementation; there is no time frame for this change or if it will happen within iCare at all. IT currently has the request. Neurosurgery stated they were concerned with ataxia with gabapentin and didn't want it on their patients. However, at least one of the neurosurgeons is using multimodal analgesia in some patients. If you question if multimodal analgesia is appropriate, please notify the PA/CRNP
If you receive feedback from a particular surgeon, please send me the surgeon's concerns so that these can be handled in a systematic way for future Cerner builds/changes.
Remember, multimodal analgesia goals: reduces the need for IV narcotics, control pain versus being reflexive to patient request, and reduce opiate exposure (Percocet, Norco) leading to less narcotic prescribing overall at discharge which would help reduce chance for drug dependency issues later. A recent webinar on pain management showed that 6-15% of patients receiving a new order for narcotics will become dependent [continued request for narcotic use after 90 days post operative].
Thanks for all you do.
Jerry Robinson, Pharm.D., BCPS
Clinical Specialist STICU/Co-Chairperson, Medication Safety Committee Department of Pharmacy Huntsville Hospital
To: Pharmacists
Sent: Thursday, October 4, 2018 7:25:30 AM
Subject: Multimodal analgesia in Adults
Multimodal analgesia management additions to various order sets have been in place for a couple of weeks. Feedback has been sent to me directly by Mr. Thomas Fender (Surgery VP, provided feedback on neurosurgeon complaints), Dr. Harriman, and Dr. Durst. All other feedback has come from nursing staff at perioperative areas.
Some surgeons have wanted certain things not done, no multimodal analgesia at all, or use only in certain patient populations.
Any surgeon/prescriber has the obvious right to order whatever is appropriate or discontinue anything they see as inappropriate for a particular patient.
However, it is the prescribers responsibility to inform us through orders of what they want to be changed. These changes can be written on a green order sheet for iCare entry, marked out on the original order sets, or noted on the original implementation order set. This is the same process for all types of orders within order sets.
To date, the only order set change request for iCare implementation has been sent in for neurosurgery order sets moving multimodal from a 'numbered' item to a 'check box' item for implementation; there is no time frame for this change or if it will happen within iCare at all. IT currently has the request. Neurosurgery stated they were concerned with ataxia with gabapentin and didn't want it on their patients. However, at least one of the neurosurgeons is using multimodal analgesia in some patients. If you question if multimodal analgesia is appropriate, please notify the PA/CRNP
If you receive feedback from a particular surgeon, please send me the surgeon's concerns so that these can be handled in a systematic way for future Cerner builds/changes.
Remember, multimodal analgesia goals: reduces the need for IV narcotics, control pain versus being reflexive to patient request, and reduce opiate exposure (Percocet, Norco) leading to less narcotic prescribing overall at discharge which would help reduce chance for drug dependency issues later. A recent webinar on pain management showed that 6-15% of patients receiving a new order for narcotics will become dependent [continued request for narcotic use after 90 days post operative].
Thanks for all you do.
Jerry Robinson, Pharm.D., BCPS
Clinical Specialist STICU/Co-Chairperson, Medication Safety Committee Department of Pharmacy Huntsville Hospital