Addressing Opioid Range Order Use in Post Anesthesia Care Units (PACUs) Across a System

Abstract

<h3>Background Information</h3> Range orders and therapeutic duplication are an ongoing issue in PACUs as we balance the unique needs of our patients with the restrictions of laws and regulatory bodies. At a previous Joint Commission visit, it had been identified there were issues with how range orders were interpreted and applied when treating patient's pain with opioid range orders in PACU Phase I recovery. <h3>Objectives of Project</h3> Identify and implement a tool to assist in standardization of PACU Phase I clinician interpretation and use of IV opioid range orders. <h3>Process of Implementation</h3> Multidisciplinary team convened to create the PACU/Recovery Room Opioid Order Management – Adult tool. Clinicians completed an in-depth Computer Based Training with a case study focus to become familiar with utilizing the tool with different patient scenarios encountered every day in the PACU. <h3>Statement of Successful Practice</h3> Chart reviews demonstrate consistency between clinicians with regard to dosing titration increments defined by the tool. The tool meets hospital policy requirements. During the most recent Joint Commission site survey, when a clinician was asked how range orders were utilized, the clinician was able to speak in detail to the tool and how IV opioid range orders are utilized in the PACU phase of care to treat pain. In the closing meeting with the Joint Commission surveyor, the tool was identified as a leading practice. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The PACU/Recovery Room Opioid Management Tool supports standardization of initial and consecutive doses of range ordered opioids, allowing nurses to continue to manage a patient's individual pain management needs with the flexibility range orders offer.