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especially since we have 8 ORs. He'd say, 'You guys aren't ordering enough.' Then he'd look at our charts and say, 'Are you guys giving enough?' He wondered if we were charting correctly." Verbal assurances that patients were comfortable upon discharge were not enough. The pharmacist challenged them to prove it with statistical data. The resulting outcomes study demonstrated the effec- tiveness of regional blocks in keeping pain under control as well as reducing the need to administer opioids in PACU. Over time, that con- tinuing review has shown a significant trend: between 2010 and 2014, only 9.78% of patients have received post-op opioids. "Our patient cen- sus is about 550 a month," says Ms. Holder, "and of those, on average, 55 to 70 patients get narcotics." This proof hasn't been cause for resting on laurels, however. "We keep tweaking," says Ms. Holder. "How can we do better, based on the numbers we see?" As opioid use data are gathered from daily chart audits and automated drug dispensing system records, the goal is to keep these numbers low, to maintain control over and decrease patients' post-op pain. At Andrews, they even analyze opioid use by specific service or type of surgery. "Whenever anything falls out, QI can take a look and give feed- back to anesthesia: Do we need to work on this?" says Ms. Holder. Alternative approach How do Andrews' anesthesia providers meet QI's challenge to keep pain and opioid use down? A lot of the credit goes to regional anes- thesia. "Regional blocks are the primary foundation of a multimodal approach," says Gregory Hickman, MD, the center's medical director and director of anesthesia. "Our orthopedic surgeries rely heavily on blocks. They make recovery faster, without nearly as much narcotics. Blocks mean less nausea and fewer side effects." In short, he says, 7 7 S E P T E M B E R 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T