“Early to Rise, Early to Home” Standing Patients on Day of Surgery Trish Davidson, PT Langley Memorial Hospital

1. “Early to Rise, Early to Home” Standing Patients on Day of Surgery Trish Davidson, PT Langley Memorial Hospital

2. Mobilizing Patients on Day 0 • Communicate plans with nursing staff • Physiotherapist:Altered hours of work for the last 3 months • Transfer/mobilize patients: with RN/LPN instead of PTA

3. Mobilizing Patients on Day 0 • Developed criteria for safely mobilizing patients on Day 0 • PO Day 1: get patients up closer to lunch time • Book patients 60 days in advance of surgery

4. Post-Operative Pain Control Langley Memorial Hospital

6. Non-narcotic analgesic Acetaminophen □ 650 mg po q6h X 72 hrs then change to 650 mg po q4-6h PRN □ 975 mg po q6h X 72 hrs the change to 975 mg po q6h PRN □ 650 mg suppository pr q6h X 72 hrs then change to 650 mg pr q4-6 h PRN

7. Nonsteroidal anti-inflammatory Celecoxib OR Diclofenac □ Celecoxib 200 mg po daily X 3 days (contraindicated in SULFA allergy) □ Diclofenac 50 mg po q8h X 3 days (may give first dose PR □ Diclofenac 50 mg pr q12h X 3 days

8. Sustained Release Preparation □ OXYCOCONE SR 10 mg po q12h (if less than 60 kg or opioid sensitive) – if necessary after 18 hours may increase to 20 mg q12h OR □ OXYCODONE SR 20 mg po q12h – if necessary after 18 hours may increase to 30 mg q12h

9. Sustained Release Preparation □ HYDROMORPHONE SR 3 mg po q12h (if less than 60 kg or opioid sensitive) OR □ HYDROMORPHONE SR 6 mg po q12h – if necessary after 18 hours may increase to 9 mg po q12h

10. Breakthrough Analgesia □ Oxycodone immediate release 5 – 10 mg po q3 – 4 h prn for Break Through Pain (BTP) – if less than 60 kg or opioid sensitie □ Oxycodone immediate release 10 – 20 mg po q3-4h prn for BTP □ Hydromorphone immediate release 1 – 2 mg po q4h prn for BTP – if less than 60 kg or opiod sensitive □ Hydromorphone immediate release 1 – 4 mg po q4h prm for BTP if > 60 kg

11. Advantages to Oxycodone SR • Around the Clock (ATC) Dosing • prevents pain • maintains a pain rating that is satisfactory to the patient • maintains a stable analgesic blood level • based on the knowledge that less drug is needed to prevent the recurrence of pain than to relieve it • prevents the undertreatment of pain in patients who are hesitant to request medication • eliminates delays patients encounter waiting for caregivers to prepare and administer pain medication

12. Advantages to Oxycodone SR • Reduced incidence of nausea and vomiting • Reduced need for antiemetics • Oral administration • I.V. can be discontinued or converted to a saline lock – one less hindrance to mobilization

13. Adjustments to the Regime • Medications ordered q12h are automatically given at 1100 and 2200 • ↑ need for PRN medications • Rapid response from anesthesiology resulted in specific direction to administer the Oxycodone SR at 0800 and 2000 hours

14. Pain – the fifth vital sign • A study in which 353 hospitalized patients were experiencing pain • Fewer than half the patients with pain (45%) had a member of the health care team ask them about their paitn or not it in the record Donovan, Dillon, McGuire 1987

15. Pain – the fifth vital sign • A study of 242 hospitalized patients with pain, a review of their records revealed that no assessments of pain intensity were documented by any caregiver. Gu, Belgrade 1993

16. Discharge Pain Regime Why change what is working?