emily edmonds coordinator state pain forms pain interest group nursing issues cnc acute pain...
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Neuraxial Opioid Single Dose Observation Chart - a dult Education Slide Presentation A presentation prepared by the Pain Interest Group Nursing Issues in association with the Agency of Clinical Innovation Pain Management Network Please direct comments to :. Jenni Johnson Manager - PowerPoint PPT PresentationTRANSCRIPT
Neuraxial Opioid Single DoseObservation Chart - adult
Education Slide PresentationA presentation prepared by the
Pain Interest Group Nursing Issues in association with the Agency of Clinical Innovation
Pain Management Network
Please direct comments to:
Emily EdmondsCoordinator State Pain Forms
Pain Interest Group Nursing IssuesCNC Acute Pain Service Blacktown Hospital
Phone: 9881 7649 Email: [email protected]
Jenni JohnsonManager
Pain Management NetworkAgency for Clinical Innovation (ACI)
Phone: 9464 4636Email: [email protected]
OR
March 21, 2013
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Neuraxial opioid single dose Observation chart - adultThe neuraxial opioid single dose observation chart for adult patients has
been developed by a team of experts in the field of acute pain including clinical nurse consultants, anaesthetists and pharmacy representatives.
Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in those patients who have received an opioid via the neuraxial route.
The term ‘neuraxial’ encompasses injections given in close proximity to the nerve roots of the central nervous system including spinal and epidural.
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Aim of this presentation:
This presentation aims to explain how to use the chart to record the administration of
an opioid via the neuraxial route how to complete the clinical observations guidelines on the management of patients who have
received an opioid via the neuraxial route including the management of adverse effects
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Neuraxial Opioid Single Dose Observation Chart - adult
Page 1:- Neuraxial opioid
administration information
- Naloxone prescription- Management
guidelines
Page 1
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Neuraxial Opioid Single Dose Observation Chart - adult
Inside pagesInside pages:- Observation
pages for up to 2 days
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Neuraxial Opioid Single Dose Observation Chart - adult
Back page:- Clinical review
andRapid Response
Criteria- Management of
adverse effects
Back page
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Patient allergy status and patient label
Private patients: require a signature from the referring Doctor to the Pain Service
Neuraxial opioid administration information
Naloxone prescription OR standing order sticker affixed
Record of naloxone administration
Management guidelines
Contact details
Page 1
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Documentation of the administration of an opioid via the neuraxial route:
Below is an EXAMPLE of documenting the administration of
an neuraxial opioid
The frequency of observations
(hourly for 6 hours or hourly for 12 hours)
must be determined by the medical officer who
administered the opioid dose
Morphine Spinal 200 micrograms09:0015/04/1
3 SMITHTSmith
Handwrite patient details or affix patient label (First prescriber to check patient label is correct if sticker is used)
Private patients: require a signature from the referring Doctor to the Pain Service
Prescriber to complete patient allergy and ADR
section in full
SMITHTSmith 15/04/13
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Naloxone prescription:
Naloxone is indicated forSEDATION SCORE 3 (difficult to rouse or unresponsive) OR
SEDATION SCORE 2 (constantly drowsy unable to stay awake) and a RESPIRATORY RATE LESS THAN OR EQUAL TO 5 breaths per minute.
This section MUST be completed in full OR a sticker affixed which states the standing
order PRIOR to any administration of naloxone.
Naloxone X 4100 microgramsIV
15/04/13 SMITHT Smith
2 -3 minutely
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Record of naloxone administration andneuraxial opioid management guidelines:
16/4/13
08:30
08:33
08:36
08:39 100 micrograms
100 micrograms
100 micrograms
100 micrograms
PLambert
TBuckley
PLambert
TBuckley
PLambert
TBuckley
PLambert TBuckley16/4/13
16/4/13
16/4/13
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Clinical Review &Rapid ResponseCriteria:
The back page of the chart displays instructions
explaining how to make a Clinical Review or a
Rapid Response
These instructions incorporate track and trigger colour zones
(from the Between the Flags
Program) to promote the recognition of the
deteriorating patient in relation to the administration
of opioids
Back page
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Clinical Review Criteria:
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Rapid Response Criteria:
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Managing neuraxial opioid adverse effects:
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RM
RMR
MR
M
1100
1200
1300
1400
1500
15/04/13
R
M
Observations:A patient label must be affixed or details written on each page
that records observations
Pain assessment: record ‘R’ for rest and ‘M’ for movement
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A sedation score or a respiratory rate in the ‘Red Zone’ requires a
Rapid Response to be initiated AND
contact the Acute Pain Service(or equivalent medical officer)
A sedation score or a respiratory rate in the ‘Yellow Zone’
requires a Clinical Review by the
Acute Pain Service(or equivalent medical officer)
2L
Ond
anes
tron
giv
en
Nal
oxon
e g
iven
2L 2L 2L 2L 8L
NP NP NP NP NP FM
NH NH NH AT AT AT
Nausea or vomiting assessmentPruritus assessment
Comments for free text
Oxygen therapy and Oxygen device
(see front page for device key)
Assessors initial
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Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in adult
patients who have received an opioid via the neuraxial route.
Comments or questions can be directed to your implementation officer or the project leaders Emily Edmonds or Jenni Johnson
(for contact details see introduction slide)
The feedback register can be located on the ACI website:
http://www.aci.health.nsw.gov.au/networks/pain-management/acute-pain-forms