Is It Worth All That Work?

 I was talking to our fantastic orthopedics floor RN Manager, Lisa Wall, a few days ago about the desk work she was doing that she said had gotten so much harder since I had been doing continuous blocks on her floor. This certainly caught my attention since I am used to RN’s telling me how so many things (some of which I never would’ve realized) are so much better with all the blocks on their floor. Lisa regularly goes through charts to evaluate and report RN performance on “Pain Reassessments”. Any time a patient reports pain, whether spontaneously or when asked, the RN is supposed to do a “pain intervention”. The RN also has to check back on the effectiveness of the intervention, a “Pain Reassessment”. The particular type of medication is not indicated, only whether or not the RN checked on their pain after the intervention.

     As it so happens [nonmember]…

 

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, prior to regularly doing continuous nerve blocks, she could compile 80 to 100 “Pain Reassessments” pretty easily by looking through about 3 charts. It is frustrating to her now as this task now requires her to look through about 15 charts to compile the same number of Pain Reassessments. She read off to me several individual charts with anywhere between 30 to >50 Pain Reassessments for typical 3 to 4 day stays from a month previous to the continuous nerve blocks. She then read off chart totals for subsequent months when continuous nerve blocks were common. “14-5-5-2-6-3-1-1-2-10-5-7-7-11-2-3-5-1”. Those numbers are striking to me! That is an obvious difference that spans months. We have had a number of total knee patients that took zero opioids during their two day stay! More notable is the fact that it is a rare occurrence for my patients to receive IV opioids, and that was not the case prior to the nerve blocks. So there are many more requests for opioids without nerve blocks, and it is much more likely to require IV opioids without nerve blocks. Beyond this, as you might expect, our utilization of antiemetics and antipruritis medications is significantly lower than in the past. I realize this is presented in an anecdotal fashion, but if (and when) I have the opportunity to quantify these numbers on a larger scale, I know it will bear out what seems very apparent to me (and to Lisa).

     I started laughing when she told me that in order to shorten the time it took to find enough Pain Reassessments, she had to start choosing medical patients instead of orthopedic patients!! Are you kidding me??? Medical patients had more pain complaints than orthopedic patients??? That’s right!! Now, I do have to admit that my patients get scheduled Tylenol and often scheduled ketorolac which medicine patients probably do not receive. It still makes me laugh!

     Is it worth all that work that I am putting Lisa through just to keep up the block program? Sorry Lisa, you better believe it is!!

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