Neuraxial Opioid Single DoseObservation Chart - adult

Education Slide PresentationA presentation prepared by the

Pain Interest Group Nursing Issues in association with the Agency of Clinical Innovation

Pain Management Network

Please direct comments to:

Emily EdmondsCoordinator State Pain Forms

Pain Interest Group Nursing IssuesCNC Acute Pain Service Blacktown Hospital

Phone: 9881 7649 Email: emily.edmonds@swahs.health.nsw.gov.au

Jenni JohnsonManager

Pain Management NetworkAgency for Clinical Innovation (ACI)

Phone: 9464 4636Email: jenni.johnsons@aci.health.nsw.gov.au

OR

March 21, 2013

2

Neuraxial opioid single dose Observation chart - adultThe neuraxial opioid single dose observation chart for adult patients has

been developed by a team of experts in the field of acute pain including clinical nurse consultants, anaesthetists and pharmacy representatives.

Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in those patients who have received an opioid via the neuraxial route.

The term ‘neuraxial’ encompasses injections given in close proximity to the nerve roots of the central nervous system including spinal and epidural.

3

Aim of this presentation:

This presentation aims to explain how to use the chart to record the administration of

an opioid via the neuraxial route how to complete the clinical observations guidelines on the management of patients who have

received an opioid via the neuraxial route including the management of adverse effects

4

Neuraxial Opioid Single Dose Observation Chart - adult

Page 1:- Neuraxial opioid

administration information

- Naloxone prescription- Management

guidelines

Page 1

5

Neuraxial Opioid Single Dose Observation Chart - adult

Inside pagesInside pages:- Observation

pages for up to 2 days

6

Neuraxial Opioid Single Dose Observation Chart - adult

Back page:- Clinical review

andRapid Response

Criteria- Management of

adverse effects

Back page

7

Patient allergy status and patient label

Private patients: require a signature from the referring Doctor to the Pain Service

Neuraxial opioid administration information

Naloxone prescription OR standing order sticker affixed

Record of naloxone administration

Management guidelines

Contact details

Page 1

8

Documentation of the administration of an opioid via the neuraxial route:

Below is an EXAMPLE of documenting the administration of

an neuraxial opioid

The frequency of observations

(hourly for 6 hours or hourly for 12 hours)

must be determined by the medical officer who

administered the opioid dose

MorphineSpinal 200

micrograms09:0015/04/1

3SMITHTSmith

Handwrite patient details or affix patient label (First prescriber to check patient label is correct if sticker is used)

Private patients: require a signature from the referring Doctor to the Pain Service

Prescriber to complete patient allergy and ADR

section in full

SMITHTSmith 15/04/13

9

Naloxone prescription:

Naloxone is indicated forSEDATION SCORE 3 (difficult to rouse or unresponsive) OR

SEDATION SCORE 2 (constantly drowsy unable to stay awake) and a RESPIRATORY RATE LESS THAN OR EQUAL TO 5 breaths per minute.

This section MUST be completed in full OR a sticker affixed which states the standing

order PRIOR to any administration of naloxone.

Naloxone X 4100 microgramsIV

15/04/13 SMITHT Smith

2 -3 minutely

10

Record of naloxone administration andneuraxial opioid management guidelines:

16/4/13

08:30

08:33

08:36

08:39 100 micrograms

100 micrograms

100 micrograms

100 micrograms

PLambert

TBuckley

PLambert

TBuckley

PLambert

TBuckley

PLambert TBuckley16/4/13

16/4/13

16/4/13

11

Clinical Review &Rapid ResponseCriteria:

The back page of the chart displays instructions

explaining how to make a Clinical Review or a

Rapid Response

These instructions incorporate track and trigger

colour zones (from the Between the Flags

Program) to promote the recognition of the

deteriorating patient in relation to the administration

of opioids

Back page

12

Clinical Review Criteria:

13

Rapid Response Criteria:

14

Managing neuraxial opioid adverse effects:

15

R

M

RMR

MR

M

1100

1200

1300

1400

1500

15/04/13

R

M

Observations:A patient label must be affixed or details written on each page

that records observations

Pain assessment: record ‘R’ for rest and ‘M’ for movement

16

A sedation score or a respiratory rate in the ‘Red Zone’ requires a

Rapid Response to be initiated AND

contact the Acute Pain Service(or equivalent medical officer)

A sedation score or a respiratory rate in the ‘Yellow Zone’

requires a Clinical Review by the

Acute Pain Service(or equivalent medical officer)

2L

On

dan

estr

on

g

iven

Nalo

xon

e g

iven

2L 2L 2L 2L 8L

NP NP NP NP NP FM

NH NH NH AT AT AT

Nausea or vomiting assessmentPruritus assessment

Comments for free text

Oxygen therapy and Oxygen device

(see front page for device key)

Assessors initial

17

Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in adult

patients who have received an opioid via the neuraxial route.

Comments or questions can be directed to your implementation officer or the project leaders Emily Edmonds or Jenni Johnson

(for contact details see introduction slide)

The feedback register can be located on the ACI website:

http://www.aci.health.nsw.gov.au/networks/pain-management/acute-pain-forms