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Anaesthesia

B51

Acute Pain Service

The Acute Pain Service (APS) takes responsibility for overall management of patients requiring advanced analgesic techniques such as epidurals, patient-controlled analgesia (PCA) infusions or peripheral nerve blocks or patients with complex acute pain problems. The majority of the patients are surgical or have pain of traumatic origin.

The APS currently sees approximately 2,600 patients per year. The APS visits these patients daily whilst under their care and also provide telephone advice when required. The Acute Pain Service at the Royal United Hospital provides this service 365 days per year and hence, in line with the present Government's intentions, has provided 7 day working for the 15 years since the service was introduced.

The core of the APS is the two senior pain-trained nursing staff (1.9 whole time equivalents Charge Nurse Bill Palastre and Sister Jane Armston) backed up by a small cohort of trained staff from the Post Anaesthesia Care Unit as well as two affiliated pharmacists. The APS anaesthetist (available 24 hours per day, 365 days per year) also covers Central Delivery Suite duties but is generally able to attend pain problems in a timely fashion.

During the APS rounds, the team scrutinise the prescription charts to ensure optimised pain relief and relief of sickness and nausea is available to the patient, as well as to correct any potential prescribing errors as an important patient safety measure. The APS continues to manage the pain of these patients with complex pain needs or advanced analgesic systems until the patient can be managed using simple analgesia or else requires referral to either the palliative or chronic pain services.

The Epidural, Patient Controlled Analgesia and Local Anaesthesia infusion policies are updated regularly on a 3-yearly cycle. Likewise, the Acute Pain Ladder is amended in line with updates.

The numbers of patients reviewed has increased annually since the inception of the APS. During 2016 the APS reviewed 2167 patients. During the year to end June 2015 this had increased to 2637, an increase of 470 patients or 21%. These numbers describe the number of different patients reviewed only. Patients with indwelling epidurals or PCAs may be followed up for several days.

 

2015

Year to May 2017

Spinal opiates

725

1333

Plain spinals

147

125

Brachial plexus blocks

135

212

Femoral nerve blocks

106

276

Epidurals

499

359

PCAs

1041

594

TAP blocks

0

26

Totals

*2653

*2925

*Totals differ from above as some patients have more than single analgesia mode.

We have a very good safety record. We currently have no Datix investigations or outstanding complaints. The existence of the APS allows safe management of patients with complex acute pain problems or using advanced analgesia techniques in the general ward setting. Totals have increased due to improved awareness of importance of good analgesia for certain conditions (e.g. # ribs) to optimise outcomes and reduce length of stay, due to improved information about the service due and to new protocols (e.g. CRACC pathway).

During the last 3 years the APS has been very involved with the Enhanced Recovery Programme (ERP) following total knee replacement to optimise post-operative analgesia and enable early mobilisation and reduced lengths of stay. This has involved working with the ward nursing staff and physiotherapists. Innovations have included introduction of adductor canal blocks and Icebands. Early mobilisation (on 'day zero') has an important effect in improving early outcome and reducing lengths of stay.

We have recently introduced a tablet-based database to allow real-time data entry on the ward round. This is facilitating data capture which will enable generation of reports.

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