Ketamine Infusion in an Outpatient Surgical Facility

Abstract

<h3>Background Information</h3> Cancer and the treatment plans associated with its management has the potential to impact a patient physically and physiologically. With the common complication being chronic pain, management can be challenging and at times suboptimal. Ketamine in subanesthetic dose is a widely used phencyclidine derivative for the management of chronic pain when inadequate response to multimodal treatments such as opioid therapy occurs. The Josie Robertson Surgery Center (JRSC) has established a ketamine infusion program to manage chronic pain in our cancer population. <h3>Objectives of Project</h3> To provide ketamine intravenous infusions for the management of chronic cancer pain in conjunction with opioid and/or non-steroidal anti-inflammatory drugs in a controlled setting of a perianesthesia unit; to acquire an extended period of pain relief. <h3>Process of Implementation</h3> A core group of eight nurses were educated in implementing the program within a limited time frame, in partnership with an interdisciplinary team including the office practice pain service. Education included hands-on training of multiple equipment, electronic documentation in a training environment, review of the potential side effects to anticipate and how to navigate effectively the various healthcare technological systems available for monitoring patients during their individualized outpatient visit. Nurses use their perianesthesia clinical judgment in following the titration order of four-hour ketamine infusion in accordance with potential side effects that patients might exhibit. Nursing competency for this program is accomplished by maintaining BLS and ACLS certifications, evaluation of knowledge of moderate sedation through a yearly examination and frequent re-evaluation of workflow created to provide an efficient service. <h3>Statement of Successful Practice</h3> Centered on patient's self-reporting of pain relief as evident by vocalizing improvement in their quality of life through reduction of pain intensity, increase in their ability to perform ADLs and repeat infusions based on long-lasting effect. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Provides perianesthesia nurses with an autonomous role to translate their perianesthesia skills for an outpatient pain service.