1. Neuraxial Opioid Single Dose Observation Chart - adult Education Slide Presentation A presentation prepared by the Pain Interest Group Nursing Issues in association with the Agency of Clinical Innovation Pain Management Network Please direct comments to : Emily Edmonds Coordinator State Pain Forms Pain Interest Group Nursing Issues CNC Acute Pain Service Blacktown Hospital Phone: 9881 7649 Email: emily.edmonds@.health.nsw.gov.au emily.edmonds@.health.nsw.gov.au Jenni Johnson Manager Pain Management Network Agency for Clinical Innovation (ACI) Phone: 9464 4636 Email: jenni.johnsons@aci.health.nsw.gov.au jenni.johnsons@aci.health.nsw.gov.au OR October 15, 2014

2. Neuraxial opioid single dose Observation chart - adult The neuraxial opioid single dose observation chart for adult patients has been developed by a team of experts in the field of acute pain including clinical nurse consultants, anaesthetists and pharmacy representatives. Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in those patients who have received an opioid via the neuraxial route. The term ‘neuraxial’ encompasses injections given in close proximity to the nerve roots of the central nervous system including spinal and epidural. 2

3. Aim of this presentation: This presentation aims to explain  how to use the chart to record the administration of an opioid via the neuraxial route  how to complete the clinical observations  guidelines on the management of patients who have received an opioid (morphine) via the neuraxial route including the management of adverse effects 3

4. Neuraxial Opioid Single Dose Observation Chart - adult 4 Page 1 Page 1: -Neuraxial opioid (morphine) administration information - Oxygen therapy - Naloxone prescription - Management guidelines

5. Neuraxial Opioid Single Dose Observation Chart - adult 5 Inside pages Inside pages: - Observation pages for up to 24 hours

6. Neuraxial Opioid Single Dose Observation Chart - adult 6 Back page Back page: - Management of adverse effects - Instructions for observations in the Yellow or Red Zone

7. 7 Page 1 Patient allergy status and patient label Private patients: pain specialist referral, name and signature of the doctor making the referral Neuraxial opioid administration information Naloxone prescription Record of naloxone administration Contact details Management guidelines Page 1

8. Documentation of the administration of an opioid via the neuraxial route: Below is an EXAMPLE of documenting the administration of an neuraxial opioid 8 Morphine Spinal 200 microgram 09:00 15/10/14 SMITH TSmith  SMITHTSmith 15/10/14 Frequency of observations determined by prescriber Handwrite patient details or affix patient label (First prescriber to check patient label is correct if sticker is used) Prescriber to complete patient allergy and ADR section in full  7511 PRIVATE PATIENTS: A pain specialist referral from the referring doctor (name), signature and date

9. Oxygen therapy and Naloxone prescription: Naloxone is indicated for SEDATION SCORE 3 (difficult to rouse or unresponsive) OR SEDATION SCORE 2 (constantly drowsy unable to stay awake) and a RESPIRATORY RATE LESS THAN OR EQUAL TO 5 breaths per minute. This section MUST be completed in full PRIOR to any administration of naloxone, unless a naloxone standing order exists in the hospital Naloxone X 4 100 microgram IV 15/10/14 SMITH T Smith 2 -3 minutely 7511

10. Record of naloxone administration and neuraxial opioid management guidelines: 10 16/10/14 08:30 08:33 08:36 08:39 100 microgram PLambert TBuckley PLambert TBuckley PLambert TBuckley PLambert TBuckley 16/10/14

11. Managing Adverse Effects The back page of the chart displays instructions explaining how to respond to patient observations in the Yellow or Red Zone 11 Yellow and Red Zone Response

12. M Observations: 12 RM R M 11 00 13 00 15 00 15/10/14 12 00 14 00 Pain assessment: Record ‘R’ for rest and ‘M’ for movement A patient label must be affixed or details written on each page that records observations RM

13. A sedation score OR a respiratory rate in the ‘Red Zone’ requires a Rapid Response to be initiated AND contact the Acute Pain Service (or equivalent medical officer) Oxygen therapy and Oxygen device/mode 13 Observations: A sedation score or a respiratory rate in the ‘Yellow Zone’ requires a Clinical Review by the Acute Pain Service (or equivalent medical officer) 2L NP 2L

14. 14 Ondansetron given PRN NH AT Nausea or vomiting assessment Pruritus assessment Assessors initial Naloxone given PRN LR AT Observations: Motor block assessment Comments for free text

15. Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in adult patients who have received morphine via the neuraxial route. Comments or questions can be directed to your implementation officer or the project leaders Emily Edmonds or Jenni Johnson (for contact details see introduction slide) 15