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Crisafi, Cheryl, RN

Schwann, Thomas, MD

Stiles, John

English

Scholarly Commons @ Baystate Health

Baystate Health Scholarly Commons @ Baystate Health Research and Education Celebration 2023 Presentations and Posters Summer 2023 Novel use of Technology to Enhance a Multimodal Approach to Pain Control After Cardiac Surgery Thomas Schwann MD Baystate Health, thomas.schwannmd@baystatehealth.org Cheryl Crisafi RN Baystate Health, cheryl.crisafi@baystatehealth.org John Stiles Baystate Health, john.stiles@baystatehealth.org Follow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/nurs_presentations2023  Part of the Medicine and Health Sciences Commons Recommended Citation Schwann, Thomas MD; Crisafi, Cheryl RN; and Stiles, John, "Novel use of Technology to Enhance a Multimodal Approach to Pain Control After Cardiac Surgery" (2023). Research and Education Celebration 2023. 31. https://scholarlycommons.libraryinfo.bhs.org/nurs_presentations2023/31 This Book is brought to you for free and open access by the Presentations and Posters at Scholarly Commons @ Baystate Health. It has been accepted for inclusion in Research and Education Celebration 2023 by an authorized administrator of Scholarly Commons @ Baystate Health. Novel use of Technology to Enhance a Multimodal Approach to Pain Control After Cardiac SurgeryCheryl Crisafi MSN, RN, Thomas Schwann MD, MBA, John Stiles PharmD, BCCP, Taylor Hodle PharmD, Daniel Engelman MD, FACSBaystate Medical Center, Springfield MAObjectiveImplement a multimodal analgesia protocol and improve MME situational awarenessMethods• We developed a MME Utilization application (MME App) which was embedded into the electronic medical record. • We collected retrospective data from 50 adult consecutive opioid-naïve patients who underwent cardiac surgery. In the first 25 patients, pain had been managed perioperatively according to standard of care (SOC group). The second 25 patients had been managed according to our multimodal perioperative pain management protocol.• The MME App was used to collect postoperative MMEs utilized. Intraoperative MME data was collected manually.2• For the purposes of statistical analysis, we calculated means and standard deviations (SD) or counts and frequencies as appropriate for the variables collected. We compared the SOC and multimodal groups using the Student's t-test for continuous variables and the chi-square test for categorical variables, except when a cell count was < 5, in which case we used the Fisher's exact test. All p-values < 0.05 were considered statistically significant.ConclusionsImproved situational awareness and implementation of a multimodal analgesia protocol significantly decreased the number of patients discharged with an opioid prescription and the amount of intraoperative opioid utilization. Figure 1Figure 2Problem8-12% of opioid naïve cardiac surgery patients become new persistent opioid users 90-180 days post-surgery.1 Traditional electronic medical records (EMR) don’t provide single, standardized metric, morphine-milligram equivalent (MME) data to guide dose adjustments to facilitate de-escalation and discontinuation decisions. (Figure 1)ResultsCompared to SOC, the multimodal group showed a 70% mean decrease in total intraoperative administration of MMEs (mean 374 ± 119.1 versus 113.5 ± 60.4 MME; p<.001) (Figure 1). There was no significant change in overall mean MME utilization in the multimodal group during inpatient postoperative convalescence. The mean MME of fentanyl was reduced by 67.7% (32.5 ± 29.0 versus 10.5 ± 29.0; p= 0.010). At discharge, the number of patients in the multimodal group who received any prescription for opioids fell by about half (84.0% vs 44.0%, p= 0.007) with a 92.5% reduction in mean MME of tramadol (47.9 ± 75.5 versus 3.6 ± 18.0; p= 0.006). (Figure 2)1. Brescia, Alexander A et al. “Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery.” The Annals of thoracic surgery vol. 108,4 (2019): 1107-1113. doi:10.1016/j.athoracsur.2019.06.0192. Engelman, Daniel T et al. “Situational Awareness of Opioid Consumption: The Missing Link to Reducing Dependence After Surgery?.” Anesthesia and analgesia, 10.1213/ANE.0000000000005923. 2 Feb. 2022, doi:10.1213/ANE.0000000000005923

Novel use of Technology to Enhance a Multimodal Approach to Pain Control After Cardiac Surgery

https://scholarlycommons.libraryinfo.bhs.org/cgi/viewcontent.cgi?article=1004&context=nurs_presentations2023

Novel use of Technology to Enhance a Multimodal Approach to Pain Control After Cardiac Surgery

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