block for the same procedure. Not only has this improved communica-
tion and led to a standardization of our blocks, it's also helped us get
patients ambulating faster by killing unnecessary multi-shot procedures.
Case in point: We realized when we were doing both a femoral and
sciatic block on patients, our patients couldn't get up to walk after-
ward. Result: People wound up staying in the hospital overnight. In
the vast majority of cases, we'll now do a single adductor canal block
in place of the femoral/sciatic combo. With this approach, we give
patients essentially the same pain relief, but they're able to ambulate
faster and be discharged sooner. Similar to traditional femoral nerve
blocks, adductor canal blocks provide rapid-onset analgesia. But
unlike femoral blocks, they spare the quadriceps so the leg can main-
tain motor strength.
3
We stopped using unnecessary opioids.
Because we're
located in a state that's disproportionally hard-hit by the opioid
crisis (Ohio leads the nation in opioid overdose deaths), we feel a
responsibility to be part of the solution. And in many ways, having the
perspective of a regional block nurse coordinator lets us do just that.
Cutting fentanyl out of our sedation process is a prime example of
how we're working to reduce opioid usage. With his spot on the pro-
cedural sedation team, our coordinator is well-positioned to ask
whether adding fentanyl was essentially just adding an unnecessary
opioid to a process that would work just fine without a narcotic. After
all, patients were receiving a local anesthetic first, so the effects of the
opioid weren't even felt. We now only use Versed (midazolam) instead
of the Versed and fentanyl, and everything works out just fine.
OSM
J A N U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 7
Ms. Berardinelli (berarda2@ccf.org) is the nurse manager at the Cleveland
Clinic Hillcrest Hospital in Mayfield Heights, Ohio, where she serves as the team
leader of the hospital's New Knowledge and Innovations Magnet Chapter.
