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1 2 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1 Standard Enhanced Recovery After Surgery (ERAS) protocols involve up to 21 different components, which is a lot to manage, says Lynda Schoppe, MSN, RN, CNOR, CAPA, CNEcl, quality and process improvement supervisor of surgical services at St. David's South Austin (Texas) Medical Center. Her facility instead employs an Enhanced Surgery Recovery (ESR) program, which focuses on ERAS protocols identified by research as key differentia- tors in outcomes: patient education; pre-op nutrition; intraoperative fluid management; early mobiliza- tion; drinking and eating soon after surgery; and multimodal pain management. The goal of multimodal pain management is to minimize the use and side effects of opioids — somnolence, hypotension, respiratory depres- sion, delirium, PONV, urinary retention and ileus. "This culminates in a move from a sick patient concept to an empowered patient concept, and promotes patient well-being throughout the sur- gical experience," says Ms. Schoppe. All patients undergoing surgery at St. David's South are treated according to ESR protocols unless the surgeon or anesthesia provider opts out for clinical reasons. Efforts to manage post-op pain begin with educating patients about the pro- gram's use of pre-op inter- ventions to make them feel better after surgery without heavy use of narcotics, which are reserved to treat breakthrough pain. Before surgery, patients are given a cocktail of acet- aminophen, gabapentin and celecoxib, which com- bine to prevent inflamma- tion. During surgery, anes- thesia providers employ opioid-sparing methods to manage pain. Post-op, patients receive acetamino- phen, gabapentin and celecoxib — and opioids as needed —until discharge. Patients who undergo orthopedic procedures also receive appropriate regional blocks to lessen the pain response. The ESR protocols have improved patient care, according to Ms. Schoppe. During pre-op assessments, patients are asked to report a comfort goal on a scale of one to 10 that indi- cates the level of pain they feel like they can manage after surgery. According to Ms. Schoppe, the pain management goal was met for 70% of the approximately 3,900 patients who participated in the ESR program. —Dan Cook POSITIVE RESULTS Streamlined ERAS Protocols Prove Successful SAME PAGE Medications selected for administration need to be clearly communicated to every member of the care team. Lynda Schoppe PACU nurses note the meds given and times of administration on a perioperative communication form, which provides for clear communication and easily accessible continuity of care," she says. • Start early. Make sure ERAS pathways are ini- tiated in the clinic at the time the decision to pro- ceed with surgery is made and tailored to specific procedures, notes Dr. Chidgey. She says pathways should be broken down into specific aspects of care: pre-op patient education; medications and regional blocks administered before surgery; intraoperative fluid management and administra- tion of pain-relieving medications; and guidelines for postoperative pain control measures, diet and