Deprescribing: implications for the anaesthetist

Hermanowski, J.; Levy, N.; Mills, P.; Penfold, N. W.

doi:10.1111/anae.13783

Cited by 12 publications

(12 citation statements)

References 12 publications

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“…Anaesthetists should provide education to all patients on how to taper/ deprescribe their analgesics after hospital admission. 7,23 It is acknowledged that opioid diversion is major cause of opioid dependency. 10 Opioid diversion occurs when people use prescribed opioids that were initially intended for someone else; justifiably The Joint Commission now demands processes for safe disposal of unwanted and expired medication.…”

Section: Deprescribing and Safe Opioid Disposalmentioning

confidence: 99%

“Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: Why?

Levy

Sturgess

Mills

2018

British Journal of Anaesthesia

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163

126

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coronary artery bypass grafting: results from the Stent or Surgery (SoS) trial. Circulation 2004;110:3411e7. 43. Hlatky MA, Bacon C, Boothroyd D, et al. Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery. Circulation 1997;96. II-11e14. 44. Avidan MS, Evers AS. The fallacy of persistent postoperative cognitive decline. Anesthesiology 2016;124:255e8.

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Section: Deprescribing and Safe Opioid Disposalmentioning

confidence: 99%

“Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: Why?

Levy

Sturgess

Mills

2018

British Journal of Anaesthesia

Self Cite

163

126

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“…anaesthetists have an important role to play in ensuring that excellent recovery is a reality [31], and that take-home analgesics are prescribed and deprescribed in a responsible fashion [32].…”

Section: Challenges Of the Peri-operative Contextmentioning

confidence: 99%

Shared decision‐making in peri‐operative medicine: a narrative review

2019

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This review on shared decision-making comes at a time when international healthcare policy, domestic law and patient expectation demand a bringing-together of the patient's values and preferences with the physician's expertise to determine the best bespoke care package for the individual. Despite robust guidance in terms of consent, the anaesthetic community have lagged behind in terms of embracing the patient-focused rather than doctor-focused aspects of shared decision-making. For many, confusion has arisen due to a conflation of informed consent, risk assessment, decision aids and shared decision-making. Although they may well be linked, they are discrete entities. The obstacles to delivering shared decisionmaking are many. Lack of time is the most widely cited barrier from the perspective of physicians across specialties, with little time available to the anaesthetist at the day-of-surgery pre-operative visit. A more natural place to start the process may be the pre-operative assessment clinic, especially for the 'high-risk' patient. Yet shared decision-making is for all, even the 'low-risk' patient. Another barrier is the flow and the focus of the typical anaesthetic consultation; the truncated format presents the danger of a cursory, 'timeefficient' and mechanical process as the anaesthetist assesses risk and determines the safest anaesthetic. As patients have already decided to proceed with therapy or investigation and may be more concerned about the surgery than the anaesthesia, it is often assumed they will accept whatever anaesthetic is offered and defer to the clinician's expertisewithout discussion. Furthermore, shared decision-making does not stop at time of anaesthesia for the peri-operative physician. It continues until discharge and requires the anaesthetist to engage in shared decision-making for prescribing and deprescribing peri-operative medicines.

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“…So I examined the incidence of opening quotations in 150 consecutive Anaesthesia editorials up to September 2017. I discovered musings from Voltaire [1] and Tolstoy [2], William Osler [3], Atul Gawande [4], and even Michael Jordan [5], The Beatles [6] and Spiderman's uncle [1]! Henry Ford put in a particularly strong showing, supplying three quotations to three editorials over the time period [7][8][9].…”

Section: An Unusual Failure Of Sevoflurane Quikfil Pen Bottlesmentioning

confidence: 99%

Don't quote me on this, but…

Scott

2017

Anaesthesia

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Deprescribing: implications for the anaesthetist

Cited by 12 publications

References 12 publications

“Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: Why?

“Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: Why?

Shared decision‐making in peri‐operative medicine: a narrative review

Don't quote me on this, but…

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