Tuesday, February 02, 2010
U. Illinois- A study conducted over a five-year period at an Illinois hospital created a pain management algorithm. The algorithm is being used to reduce the number of injuries and deaths related to errors in how pain management drugs are administered to patients in the hospital.
“A prescription is a treatment plan. And that treatment plan is, in its most general sense, an algorithm.” says Ian Brooks, head of the health sciences research group at the National Center for Supercomputing Applications at the University of Illinois.
He further explains that the processes used in developing a computer science program can further be applied to the process of prescribing medication. The definition of an algorithm is a precise set of rules for solving a problem. The study looked at prescriptions as a medical algorithm. Brooks helped create and debug the algorithm, which was tested at the OSF Saint Francis Medical Center in Peoria.
The researchers, which included nurses, doctors, pharmacists, clinical pharmacologists, quality assurance specialists and statisticians, worked with adult orthopedic surgery patients. Once anesthesia and surgical pain medications were out of the patients system, non-opioid analgesics such as acetaminophen were given. The patients were administered these non-analgesic drugs on a fixed round-the-clock schedule. This tactic cut the patients opioid medication requirements in half.
The opioid fentanyl was then given through subcutaneous catheter. The drugs were
provided via a patient controlled pump, which allowed the patients to have more control over their own pain management.
Patients reported the severity of their pain on a pain scale. The pain scale allows a patient to slide a marker to indicate the level of pain that they are experiencing. The scale went from a range of no pain on the far left, to extreme pain on the far right. Nurses would flip the scale over to see the number that corresponded to the marker placement, then follow the protocols for that pain number. The protocols also included orders to handle common post-surgical complaints such as
nausea and constipation. The algorithm has detailed protocols for responding to severe adverse reactions associated with opioid drugs.
The results of the study were very promising. During the beginning of the study there were seven severe or fatal adverse drug events (ADEs) in one month. Once the protocol was introduced and was consistently followed, the number decreased until reaching the point of zero deaths from ADEs for the final six months of the study. These results were published in Clinical Pharmacology and Therapeutics. Once the study was concluded, the protocols went hospital-wide. Since the implementation of these protocols more than six years ago, the hospital has not experienced a single adverse drug event relating to opioid-based pain medication.
“The ward nurses loved it,” Brooks says. The nurses were able to easily convert pain measurements into direct action through patient care, and, more importantly, the protocol empowered them to take action.
The protocol also opened up the around the clock use of non-prescription over the counter (OTC) analgesics to reduce the patient’s need for opioids. Maintaining the dose of these OTC analgesics managed pain in patients, reducing the use of stronger drugs.
With the leaps being made in electronic medical records and expansion of the use of computers in hospital wards, the researchers believe the time is right to pursue digital prescription protocols and expand their use.
Researchers involved in the study were from NCSA, the University of Illinois College of Medicine in Peoria, OSF Saint Francis Medical Center in Peoria, and Jesse Brown Veterans Affairs Medical Center in Chicago.
NCSA news: http://www.hospital.com/www.ncsa.illinois.edu/News/Stories/Painmgt/Thursday 14 January 2010
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