Describe your pain service...

[djmatte, ADN, MSN, RN, NP]

As some of you recently saw, I picked up a position working for a pain service. Well suffice to say there is a LOT more involved in this job than I ever anticipated. With that thought in mind, I wanted to compare/contrast how other hospitals who provide this service run it? This is sort of to give me an idea of what other hospitals do in comparing, as well as to identify those places if I decide to move to a new spot.

For starters, we are not so much a hospital service, but an arm of anesthesiology.

Our primary focus is post op patients who receive epidurals, management of those epidurals through the postop process, and DC'ing/following up with the patient outcomes. Other side things we do is keep an eye on patients who had failed epidurals either prior to, during, or after surgery for 24 hours to ensure a hematoma hasn't formed.

Within that service is where it becomes WAY more than I thought. Now at first, I thought we were doing things that NP's, CRNA's or other advance practice nurses should be doing. but when a friend explained that its not too far off from what we do in PACU (my other job) where we operate within set parameters and order sets, it made a bit more sense.

Now as I stated, we are the arm of anesthesiology. We round on the patients in the AM, once in the afternoon with the anesthesiologist, then again on our own at night. All orders are placed by the RN's (with MDA cosign when they review their orders) at the RN's discretion and will include everything from what specific epidural cocktail will be given, how much if any of duramorph a ortho patient will receive, as well as any side effect meds that need to be placed on the order set (benadryl, zofran, nubaine, etc). If a patient has some sort of unilateral block, the pain RN will work to resolve it (sometimes from adjusting the depth of the catheter). We assess the sites on every round, and ensure documentation is done for every patient at least once per day.

Another big role is coordination of services. We don't handle PO pain meds because its the primary service that does that, but we do have to make them aware when we DC catheters and ensure that the patient has something ordered for pain once the epi is done. We also monitor those services notes to make sure how long the anticipate needing the catheter, when foleys are being DC'd and when the patient is expected to tolerate foods.

TL/DR: Our Pain Service is a lot of work...but really versatile and one heck of an opportunity for people looking for more autonomy and a TON of responsibility. Whats yours like?