Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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M A R C H 2 0 2 1 • O U T P A T I E N T S U R G E R Y . N E T • 11 that response, by decreasing inflammation or nerve excitability, the result is often better pain control postoperatively." Getting ahead of pain with a targeted and multi- disciplinary approach makes sense for complex cases, but are ERAS protocols worth implement- ing for less invasive surgeries? Absolutely, says Susan Hukill, DNAP, MSNA, CRNA. "Even a single pre-op dose of acetaminophen before a 'minor' surgery is beneficial," explains Dr. Hukill, chief nurse anesthetist at St. David's South Austin (Texas) Medical Center. "Regardless of how big or small the procedure, ERAS pathways benefit the outpatient population." Essential elements There's been a big push to implement enhanced recovery protocols in hospitals and surgery centers over the past couple of years, according to Dr. Hukill. "Members of the anesthesia community talk about the benefits of practicing opioid-free anesthe- sia," she says. "The ability to potentially eliminate opioids from surgical care is partly dependent on the successful implementation of ERAS protocols." The increasing numbers of surgeons who are publishing studies that report successes with ERAS pathways are inspiring others to add the protocols in their practices. However, says Dr. Chidgey, ERAS programs remain difficult to implement. "It takes a true multidisciplinary approach to develop a com- prehensive plan," she points out. "Implementing ERAS protocols also requires disrupting 'the way it has always been done' mentality." Here are a few ways to overcome the inertia that prevents improved patient care: • Collaborate and communicate. Practices designed to enhance recoveries can improve post- op pain management, but determining how to implement them consistently and effectively requires a coordinated effort from a team of committed providers. ERAS pathways are gener- ally made with a collaborative effort among sur- geons, anesthesiologists, pain specialists and nurses. "Together they can voice their concerns and goals regarding their specific areas of focus," says Dr. Chidgey. "They discuss care plans and make revisions based on evidence in the litera- ture and specific circumstances with their facili- ty-specific processes." Promote closed-loop communication among providers along the continuum of care, notes Dr. Hukill. "Strategies must be in place to make sure the medications used are appropriate for each individual patient," she explains. "The documenta- tion of what medications were given must be avail- able for all providers to access in a timely manner. It's essential that anesthesia providers and pre- operative staff keep the lines of communication open so that additional medication doses are not inadvertently administered." Lynda Schoppe, MSN, RN, CNOR, CAPA, CNEcl, quality and process improvement supervisor of sur- gical services at St. David's South Austin, believes clear communication among providers is particular- ly important when administering acetaminophen, which has a 4000mg dosing limit per 24 hours. "Have pre-op nurses, anesthesia providers and ALL FOR ONE Brooke Chidgey, MD, seen here prepping a patient for an epidural, says ERAS protocols involve constant communication among dedicated providers. Brooke Chidgey