Patients who are resting at home or sleeping in their own beds with no one disturbing them every hour are less likely to wake up and get up to take medication for mild pain.

EHR Could Help Prevent Overprescribing One underutilized tool in the ASC set- ting in the battle against opioid addic- tion is the electronic health record (EHR). According to a July 2018 study in JAMA Surgery, decreasing the number of pills prescribed through an EHR is an economical and conve- nient way to prevent overprescribing and track the use of pain medications. Using an EHR, ASCs can stan- dardize order sets. Setting standard order sets for the treatment of pain by the anesthesia team would assist in the implementation of an effec- tive multimodal analgesia protocol. Low-dose pain management requires multidisciplinary communication and coordination. An EHR allows mul- tiple users to concurrently chart the same patient, which allows all provid- ers to be aware of pain assessment, vital signs and medication adminis- tration for their patients throughout the continuum of care.

Addressing pain early requires

lower doses of medication and will respond to non-medication pain con- trol options (e.g., ice, positioning and relaxation techniques). The EHR also provides a medication summary for the current visit and shows providers the total amount of medications admin- istered during the visit in real time. This prevents overmedication due to lack of information on how much has been given so far. The EHR’s medi- cation reconciliation section also pro- vides a convenient way to evaluate the patient’s home medications and any interaction they have with the planned discharge medications.

ASC FOCUS FEBRUARY 2019 | 21 The plan for the treatment of post-

operative pain starts before surgery and ends well after the patient has gone home. An EHR allows the sur- gery center and the care providers to design questionnaires specific to their surgeries and the known patient pop- ulation. Gathering the appropriate information prior to surgery ensures that the best possible plan for the appropriate combination of pain ther- apies is ascertained and made avail- able for the patient. The EHR also allows the center to design discharge instructions by procedure that include an educational document for patients being discharged on opioids, thereby substantiating the review of this docu- ment with the patient and/or family to stress adherence to the prescriptions and provide alternative interventions to opioids for pain management.

Last, an EHR can provide data for accountability and analysis. Reports that allow the center to track the usage of opioids by procedure, order- ing provider and administering per- sonnel also allow careful monitoring of opioid administration and trending of usage. The ability to report opioids given at an ASC helps reduce and track any potential overuse. All health care providers must play a role in decreasing the use of opioids. One way to do that is to use the tools available in more inventive ways to care for, monitor and educate patients and our colleagues. The EHR is a new tool for ASCs that can play an effec- tive role in this crisis.

Maura Dent Cash, RN, is the director of clinical applications at HSTpathways in Lafayette, California. Write her at

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