answerman

That seems like best practice. I see no real need for the pain pump to be in the O.R. The bolus of local anesthetic usually has a half life of perhaps up to 4 hours. Is this a tissue / wound infiltration or peripheral nerve block or a combination of both techiques? One large insurance carrier has made a statement regarding which approach they intend to pay for and which technique they do not pay for based on efficacy as demonstrated by VAS Pain Scores and reduction of adjunct narcotics ordered.

More information from the University of Chicago on pain pumps. The STRYKER Pain Pump 2 has been discontinued. It is not an "elastomeric" pump but a disposable programmable electronic infusion pump. http://dig.pharm.uic.edu/faq/Sep10/elastomeric.aspx Regards, Answerman

Hello Deb: Thank you for your positive feed back. Regards, TJG

The best way to fill a pain pump is for the pharmacy to fill and dispense as with any sterile medication according to the USP 797 regulations that basically says that mixing at the back table is a "high risk" procedure for infection and that compounding under a Class II hood in pharmacy would reduce this to a "moderate risk". The surgeon who orders the use of the pain pump is taking on the liability of this risk in the O.R. His or her M.D. superceeds that of the Pharm D or R.Ph. If there is no policy & procedure written (which is often the case) then nursing may be open to risk as well. When there is a law suit ( and many lawyers are going after "pain pumps" using fenestrated catheters at the close of the procedure when they are placed in a position that allows the local anesthetic to come in contact with the tendons which may be causing Chondrolysis > see NYS Time article: http://www.nytimes.com/2010/01/27/sports/27painpump.html ). Some hospitals are not protecting the nurse from litigation when the nurse is performing a task that has not been vetted by the institution. The lack of a written policy & procedure usually happens by omission rather than commission. It is alway best to write a policy, train according to your policy and annually review such policies, especially in the abscence of any industry guidance. No one can find fault if you are making the conscious effort to protect the safety of the patient. If the pump is to go home there may be issues concerning the proper labeling of the device with the drug and RX, etc. Many hospitals may be in violation of their state pharmacy laws since they may not have an out-patient pharmacy license or have no documention for what is dispensed as is often the case when the pump is filled in the O.R. There are now national and local "closed door pharmacy" companies that fill cassettes, pumps, reservoir bags with bupiv or ropiv for about $80.00 and often bill the patient directly if they have coverage for RX drugs. Therefore there is no cost to the facility, more documentation and less risk for nursing. An electronic, resuable pain pump is often best since accuracy is +/- 6% versus +/- 15% plus temperature variations for elastomeric pumps and again the electronic resuable pump gives HX for the Rx, patient activation of bolus doses as well as VTBI and Total Volume Infused. If it isn't documented... it isn't done! There is a PCA pump on the market that costs just about $800 and is considered "DME". When used for chemo or chronic pain this device is billable under HCPCS E0781 & A4222 yielding revenue of $242 per month (even if used for a day, week or month) for rental of the pump and $42 for the cassette. There may be some reimbursment for the pump and associated pain control kits that would reduce the cost versus a purely disposable device costing $175-$300 dollars. This is a state by state regulation. For orthopaedics the use of Continuous Regional Anesthesia & Post-Op Analgesia using a contiuous nerve block vs a single shot yields better pain mgt. than a fenestrated catheter in the wound. It also has the added benefit of blocking pain in a non-narcotic mode before, during and up to 3-5 days after surgery. It is placed "remote" from the surgical site and has a lower incident of catheter infection. Anesthesiologist now have the benefit of using ultra-sound placement technique which reduces the the "art" of establishing a good block beyond using paresthesia / stimulation. Reimbursement for placing a catheter is about $300 or up to $1,000+ for workers comp cases. Narcotic dependent patients are a small sub-set of surgical pateints that greatly benefit from the CPNB technique. MedSurgReps