Introduction

The Ohio State University Medical Center (Columbus, OH) was selected as a finalist for the inaugural Health Devices Achievement Award, announced in June 2006, for its submission describing the organization's process for implementing a new patient care technology: local anesthetic pumps.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. Learn about the other submissions that achieved recognition.

ECRI congratulates the applicants: Jayne Henry, Crystal Tubbs, and David Smeenk. 

Discussion

After reviewing research in the clinical literature, staff at OSU Medical Center had become interested in the use of pumps to administer local anesthetics (bupivacaine or ropivacaine) in the surgical or perineural site as an alternative to more traditional postoperative pain management methods, such as the intravenous or epidural administration of opioids (narcotics). Research had suggested that this modality of pain management would offer benefits such as increased pain relief, decreased nausea and vomiting, lower opioid consumption, and shorter hospital stays.

To determine whether the medical center's patients could benefit from this technology, a proposal was evaluated by the center's Clinical Technology and Product Assessment Committee (TAC), which assesses the merits of new technologies. This committee debates the quality of clinical evidence, the clinical and financial benefits, and whether and how well the proposed technology fits in with the medical center's mission and values.

Because a decision to implement local anesthetic pumps would affect multiple patient care areas—including ambulatory surgery units, operating rooms, postanesthesia care units, intensive care units, and surgical nursing units across the health system—the OSU committee performed a systemwide assessment to judge the desirability of the technology and the potential implications of its adoption.

Once a decision to adopt the technology was made, the TAC developed an implementation plan. As in most cases, a small multidisciplinary team was appointed to ensure the safe implementation of the technology across the medical center. The medical center has found that a focused, multidisciplinary team—including individuals who would be affected by the technology under consideration—is an effective structure to oversee the introduction of a new technology that affects multiple departments.

The implementation team was charged with several tasks:

• Evaluating available pump technologies and selecting appropriate devices. It was determined that two pump styles—one fixed-rate pump and one programmable pump—would be needed.

• Developing procedures and protocols for local anesthetic pump technology. Step-by-step procedures and protocols were developed for specific disciplines and were made available in multiple formats (e.g., on paper, through the medical center's intranet). To maintain compliance with the United States Pharmacopoeia regulation USP 797 (which sets practice standards to help ensure that compounded sterile preparations are of high quality), the team instituted a process of having all local pain management pumps filled in the pharmacy.

• Developing a computerized provider order entry (CPOE) process and order sets to support the use of local pain management pumps. This was a particularly challenging task, since the facility's CPOE system could not support the new routes of administration (perineural and cutaneous) without significant modifications. Until such modifications could be made, a paper-based process was developed.

• Developing and coordinating education for all disciplines, including physicians and physician assistants, nurses and nurse practitioners, and pharmacists and pharmacy technicians. Educational booklets were developed for each pump that included the medications used, an outline of the process from physician order to patient discharge, examples of paper and electronic orders, and pump-specific instructions. In addition, device suppliers provided education and support at the point of care for each discipline and also supplied relevant manuals and educational materials.

• Developing appropriate educational materials for patients and their families. These materials included details on the care of their pump, troubleshooting guidance, instructions for care of the catheter site and for catheter removal, and information describing when to contact the doctor.

These steps were completed successfully, and patients in several care areas—including urology, bariatrics, and orthopedics and podiatry—are now treated using this modality of pain management. Our members at OSU report that the medical center's experience with the technology has been consistent with the implementation team's expectations: The use of local anesthetic pumps has significantly reduced the side effects associated with narcotic pain management and has led to improved patient and physician satisfaction. In fact, interest in this approach has been expressed for other patient populations across the medical center.