Chu, Everett

Dangerfield, Paul

Dela Cruz, Philip TH

Greenwood, Adam

Ho, Geoffrey

Lubran, Rachel

Podolnick, Jason

Pudalov, Natalie

English

George Washington University: Health Sciences Research Commons (HSRC)

BACKGROUND• The opioid epidemic poses challenges for inpatient pain management• Nerve blocks reduce opioid usage in acute pain• Improved patient satisfaction• ↓↓ opioid side effects & addiction risk• Blocks had to be done in post-anesthetic care unit (PACU) or Intensive Care Unit• Delays were due to lack of transport, PACU beds etc.Implementing Bedside Regional Anesthesia: Improving Clinical EffectivenessGeoffrey Ho M.B.B.S., Everett Chu M.D., Adam Greenwood M.D., Jason Podolnick M.D., Rachel Lubran R.N., Natalie Pudalov B.A., Philip T.H. Dela Cruz B.S., Paul Dangerfield M.D.Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington D.C.P• Identified stakeholders• Identified delays to blockD• Surveyed Acute Pain ServiceC• Perception was delays were non-clinicalA• Created ‘Mobile Block Team (MBT)’• Consulted Nursing Leadership and PharmacyP• Test ability of MBT to improve efficiencyD• Compare number of procedures done before and after implementationC• Retrospective analysis proves improved efficiencyA• Promote this intervention to other pain servicesP• Purchased equipment• Established safety protocolsD• MBT piloted Jan 2019• Efficacy measured in Aug 2019C• Analysis proved significant time saved with MBTA• Advertised to Department• Use of MBT encouragedDCAPDCAPDCAP3 months12 monthsOBJECTIVESIn October 2018, we started planning a ‘Mobile Block Team’ (MBT) with the goals of:• Reducing delays to block non-perioperative patients Improving efficiency of the Acute Pain ServiceMETHODS• In January 2019, we piloted the MBT, comprising of• Attending Acute Pain Anesthesiologist• Anesthesiology Resident• 2 Registered Nurses • Safety protocols agreed with Nursing Leadership• Equipment: 2 backpacks, portable ultrasound & monitor• Success of service assessed in two phases• Phase I – Prospective case-control• Phase II – Retrospective analysis Resident assesses and consents patientTeam dispatched to patient bedsideSafety ‘timeout’ performedBlock performedPatient vitals monitored for 30mins postFigure. Process of block administration with the MBTMETHODS (CONTINUED)• Phase I – Prospective Case-Control• 12 non-perioperative patient encounters in August 2019• 6 Control : PACU blocks• 6 Case : Mobile blocks• Non-clinical time per case recorded• Phase II – Retrospective Analysis• Number of cases from October 2018 to December 2019RESULTS• Phase I• PACU block delays triple Mobile blocks• 61 minutes vs 19.5 minutes (p = 0.004)• Phase II• Average increase of 217% in non-perioperative blocks per month (6.7 to 20.9; p = 0.009)• Average increase of 155% in total blocks per month(138.3 to 215; p = 0.004)• No staff changes during this period• No block-related complications Figure. Number of regional blocks performed from Oct 2018 to Dec 20190255075100125150175200225250275300Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecTotalPeri-operativeNon-perioperative2018 2019MBT introducedFigure. Plan-Do-Check-Act cycles of planning and developmentCONCLUSIONS• Bedside blocks reduced waiting time for patients needing blocks• Improved efficiency translated to more blocks done overall• Successful program that is replicable in other institutionsAcute Pain Nerve BlocksPerioperative ~ 90%Non-perioperative~ 10%• Acute Pain Service (APS) unable to meet ↑↑ demand for blocksBACKPACK 1Pre-procedure Bedside ChecklistConsent FormsSurgical caps and face masksEmergency rescue medication Atropine and Glycopyrrolate Epinephrine  Phenylephrine  EphedrineLocal Anesthetic Lidocaine 1%  Ropivacaine 0.25/0.5% Bupivacaine 0.25%/0.5%BACKPACK 2Sterile drapes & ultrasound probe coverSterile surgical gloves (assorted sizes)Block needles and Catheters (assorted sizes) and needles for skin infiltration of local anestheticDressing pack: Clear adhesive dressings  Benzoin Biopatch DermabondChlorhexidine or Betadine for skin preparationInfusion linesACKNOWLEDGEMENTSWe would like to thank Ivy Benjenk R.N., M.P.H., Jessica Mersinger R.N., Kristy Schnell R.N., Charlene Batac R.N., Brigit Hynes R.N., Debbie Rose N.P. and Renee Theisen N.P. for their invaluable assistance.

Implementing Bedside Regional Anesthesia: Improving Clinical Effectiveness

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?filename=0&article=1003&context=smhs_anesth_facpres&type=additional

Implementing Bedside Regional Anesthesia: Improving Clinical Effectiveness

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