Home analgesics re-ordering– there continues to be patients missing their home dose of analgesics on the APS orders at the Holland Centre and at Bayview. This results in unnecessary pages to the APS NPs and can result in delays in patient discharges. While it is the duty of the APS NPs to assist with clarifying orders, the primary responsibility lies with the Anesthesiologists to ensure that the home analgesics have been reconciliated and appropriately re-ordered after discussion with the patient. If you have any questions or concerns, please liaise with the APS team.
Running list with APS NPs (Holland)– please ensure that the APS NPs are running the APS patient list with you. The PAC staff (weekday) and Holland #1 (weekend) should review the full list of patients with the APS NP on shift at the default time of 13:00. This ensures patients are appropriately cared for, NPs are supported, and billing of this care is accurate.
Timeliness of ESP catheter insertions– rib fractures are associated with high risk of morbidity and mortality. Recent query from trauma service and ICU about whether some ESP catheter insertions can be expedited. There is recognition from other services that ESP and other regional anesthesia techniques are best suited for managing rib fracture pain. Agreement from Pain Committee that catheter insertions should be prioritized based on severity, for spontaneously ventilating patients, and triaged appropriately. Mechanically ventilated patients awaiting liberation from ventilation may benefit from ESP catheters however limited evidence exist. When on APS or in Block Room, if you are not capable/comfortable with the procedure, please identify someone in the OR who can and break them out for the procedure.
ED ESP catheter infusions– patients who have their ESP catheters inserted in the block room or in ED can have their infusions started in ED. Nurses in ED have had training in setting up and starting these infusions. Please continue to support any queries from the ED overnight relating to this whenever possible.
APS orders for signing off from HPB- Pharmacy has requested whether APS can clarify whether to continue rectus sheath/MOTAP catheter infusions when signing off. This is to ensure that infusion orders are not removed when APS signs off. Recommendation is to write “APS signing off, continue peripheral nerve catheter infusions under the care of hepatobiliary service”
No Comments