The Clinical Nurse Specialist Role in Enhanced Recovery After Surgery
Topic of Interest
Pharmacology
Patient Populations
Interprofessional Collaboration
Abstract
Significance & Background: Increased narcotic use in surgery patients has contributed to the current national opioid crisis, extended length of stay, readmissions for inadequate pain control, and increased risk of complications. At a large academic medical center an interdisciplinary team adopted an Enhanced Recovery After Surgery (ERAS) protocol to mitigate risk of opioid addiction among thoracic surgery patients.
Evaluation Methods: An assessment of prescribing patterns and outcomes data drove the initiation of ERAS. Data revealed that the thoracic surgery service was the second highest prescriber of narcotics with an increase in epidural adverse events, inadequate pain relief, and pain-related readmissions. The ERAS protocol was implemented to improve patient pain management via opioid-sparing techniques and multimodal analgesia throughout the patient’s care continuum.
Outcomes: Content experts developed an algorithm, guiding providers and nurses on a collaborative stepwise approach in managing acute post-operative pain. The thoracic surgery clinical nurse specialist (CNS) collaborated with the thoracic surgery chief, nurse practitioners, pharmacist, nurse manager, and clinical nurse leads to educate nurses on administering, monitoring, and assessing side effects for each medication. Educational methods included multi-tiered in-services, “just in time” education, and huddles. Following implementation of the protocol, epidural adverse events were eliminated; 80% of patients were discharged on Tramadol with zero pain-related readmissions.
Implications: The CNS, along with interdisciplinary team members, plays a vital role in the successful and sustained adoption of ERAS protocols to improve patient safety and pain management.