COMPREHENSIVE PAIN SERVICE “GOLDEN RULES”
1. Make the patient comfortable BEFORE leaving PACU (NRS Pain Score ≤ 4, unless baseline pain score is higher).
2. Document all patient encounters in the medical record.
3. Call staff for any questions- that is why we are here.
4. Notify the nursing service if you are using new medications, techniques, etc. Document this.
5. If you bolus a catheter with local anesthetic, remain with the patient for a reasonable time (i.e.,20-30 min) and document vital signs and effects after the bolus, or ensure they have appropriate monitoring and a responsible provider is anticipating potential complications of the bolus (e.g., PACU nursing staff).
Be prepared with the backpack stocked to treat complications such as over-sedation, hypotension, airway emergencies, and the like with available agents specific to the issue at hand
6. If an epidural is discontinued secondary to malfunction and a PCA is instituted, recheck the patient after starting PCA to ensure comfort prior to “signing off”. Notify the primary service of these changes.
7. Don’t let the primary service use you for management of every systematic complaint. For new complaints, find out if the patient has first been evaluated by the primary service. Remember that we are a consultative service. Unless this is an anesthesia related complication or situation, every patient will have a primary service. They are responsible for their own patients, and we are just offering our suggestions and help for a specific problem.
8. Make sure you are trained on how to operate PCA/ epidural pumps prior to starting your CPS rotation. If you are unsure of programming, do not make changes to these machines. Make sure that every change is documented, and make every effort to discuss with the nursing staff, and the primary service as appropriate.
9. Thoracic epidural catheters for thoracotomies, thoracic trauma, and upper abdominal surgeries are encouraged. This maximizes available agents for epidural use, particularly local anesthetics.
10. Consults received prior to 13:00 will be seen that day.
11. Wear a mask and use meticulous sterile technique when placing a catheter. Always use a chlorhexidine and alcohol combination product for skin antisepsis. Foam in and Foam out!