Practice Guidelines for Postanesthetic Care

Apfelbaum, Jeffrey L.; Silverstein, Jeffrey H.; Chung, Frances; Connis, Richard T.; Fillmore, Ralph B.; Hunt, Sean E.; Nickinovich, David G.; Schreiner, Mark S.; Barlow, Jared C.; Joas, Thomas A.

doi:10.1097/aln.0b013e31827773e9

Cited by 213 publications

(69 citation statements)

References 65 publications

(47 reference statements)

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“…This resulted in exclusion of two guidelines intended for anesthesiologists that focused exclusively on peri-operative management and included use of advanced management procedures beyond the scope of practice for general internists, 20, 21 and one guideline focused on management in the intensive care unit. 22 Within the set of guidelines included in this review, we did include recommendations designated for the post-operative period that we felt were relevant to the care of hospitalized patients more generally.…”

Section: Discussionmentioning

confidence: 99%

“…As previously noted, in order to avoid substantial heterogeneity in management recommendations we excluded two guidelines intended for anesthesiologists that focused exclusively on peri-operative management, 20, 21 and one guideline focused on management in the intensive care unit. 22 Accordingly, recommendations contained in this review may or may not be applicable to those settings, and readers interested in those settings specifically are directed to those guidelines.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Herzig

Calcaterra

Mosher

et al. 2018

Journal of Hospital Medicine

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Background: Pain is common among hospitalized patients. Inpatient opioid prescribing is not without risk. Acute pain management guidelines could inform safe opioid prescribing in the hospital and limit associated unintended consequences. Purpose: To evaluate the quality and content of existing guidelines for acute, non-cancer pain management. Data Sources: The National Guideline Clearinghouse, MEDLINE via PubMed, websites of relevant specialty societies and other organizations, and selected international search engines. Study Selection: Guidelines published between January 2010 to August 2017 addressing acute, non-cancer pain management among adults were considered. Guidelines focused on chronic pain, specific diseases, and non-hospital setting were excluded. Data Extraction: Quality assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Data Synthesis: Four guidelines met selection criteria. Most recommendations were based on expert consensus. Guidelines recommended restricting opioids to severe pain or pain that has not responded to non-opioid therapy, using the lowest effective dose of short-acting opioids for the shortest duration possible, and co-prescribing opioids with non-opioid analgesics. Guidelines generally recommended checking the prescription drug monitoring program when prescribing opioids, developing goals for patient recovery, and educating patients regarding risks and side effects of opioid therapy. Additional recommendations included using an opioid dose conversion guide, avoidance of co-administration of parenteral and oral opioids, and using caution when co-prescribing opioids with other central nervous system depressants. Conclusions: Guidelines, based largely on expert opinion, recommend judicious opioid prescribing for severe, acute pain. Future work should assess the implications of these recommendations on hospital-based pain management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Herzig

Calcaterra

Mosher

et al. 2018

Journal of Hospital Medicine

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“…Currently, there exists a recommendation published by the German Society of Anesthesiologists that the bladder function has to be taken into consideration before discharge in an ambulatory setting [19]. On the other hand, a recently published article by the American Society of Anesthesiologists Task Force on Postanesthetic Care stated, that the routine requirement for urination before discharge should not be part of discharge protocol and may only be necessary for selected patients [20]. In a recent review, Mulroy stated that low-risk patients, as studied in the present trial, are at no greater risk of retention than after general anesthesia, and may be discharged home with similar instructions regarding return if unable to void [21].…”

Section: Discussionmentioning

confidence: 99%

Discharge times for knee arthroscopy in spinal vs. general anesthesia

et al. 2014

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“…[5] and the Collaborative Alliance for Nursing Outcomes (CALNOC), and the perioperative arena. Although organizations such as the American Peri-Operative Registered Nurses (AORN), [6] the American Society of Peri-Anesthesia Nurses (ASPAN), [7] and the American Society of Anesthesiologists (ASA) [8,9] have recommended standards and practice guidelines, no specific nurse-sensitive clinical indicators were found on these organizations' websites. In addition to the literature review, numerous regional and national Magnet hospitals were queried.…”

Section: Background and Significancementioning

confidence: 99%

Charting the course for American Nurses Credentialing Center–Approved perioperative nurse-sensitive indicators

Shepherd¹,

Hawthorne²

2017

JNEP

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The current health care environment, with increasing public awareness of and attention to patient safety, mandates the delivery of exceptional quality care. To meet the health care requisites of the perioperative patient population, clinical nurses have identified the need for nurse-sensitive clinical indicators for this setting. We describe the strategies used to identify, obtain American Nurses Credentialing Center approval for, and integrate nurse-sensitive indicators into the perioperative setting to advance a Magnet culture. Prior to this, nurse-sensitive indicators for the perioperative setting that enabled nurses to monitor and improve patient care outcomes, in accordance with the standards of a Magnet-recognized hospital, had not been formally established. A review of the literature yielded a list of potential metrics, which included normothermia, patient falls with harm, and retained surgical items. Methodology and data collection processes for these metrics were established, facilitating quarterly Nursing Dashboards and collaboration among nurses to improve patient outcomes. This groundbreaking initiative enables nurses to routinely evaluate whether the structures and processes of care effectively yield quality outcomes. This foundational work has broader implications for nursing practice, because these quality metrics can easily be translated into perioperative settings in other health care organizations.

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Practice Guidelines for Postanesthetic Care

Abstract: Supplemental Digital Content is available in the text.

Cited by 213 publications

References 65 publications

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Discharge times for knee arthroscopy in spinal vs. general anesthesia

Charting the course for American Nurses Credentialing Center–Approved perioperative nurse-sensitive indicators

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