American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Activities Underway through ACS Quality Programs

MBSAQIP—ENERGY

(Effective March 2018)

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) currently supports a national quality improvement initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (ENERGY). Overarching goals of the ENERGY are to enhance patient experience through improved pain management, fewer opioid side effects (nausea, vomiting, ileus), decreased readmissions, and quicker return to normal activity. There are 36 accredited bariatric surgery centers nationwide participating in this initiative which is expected to run through late 2018.

Specific interventions in the ENERGY project focus on multi-modal pain strategy utilizing non-opioid analgesics and long acting local anesthetics, minimization of opioid use, appropriate fluid management, rapid anesthesia reversal, minimizing insulin resistance, early post-op diet advancement and ambulation, and avoidance of nasogastric tubes and abdominal drains. The commitment of centers to reduce opioids is noted in their adherence with the process measure of a non-narcotic pain regimen 76.7 percent of the time as noted from the first quarter data from the project.

Of the 28 process measures, seven are directly related to opioid reduction. These process measures direct participating centers to follow an opioid-sparing pain regimen and to collect data with regard to opioid use or avoidance.

Centers measure the following:

  • Did the patient receive Tylenol/Celecoxib or Tylenol/Ketorolac?
  • Were opioids used for induction of anesthesia?
  • Were opioids used during the surgery?
  • Was a regional block or Lidocaine drip used during the surgery?
  • Did the patient receive a non-narcotic pain regimen?
  • Did the patient receive any opioids postoperatively?
  • What was the Morphine equivalency dosing of narcotics the patient received?

Local endorsement and adoption among all specialties (surgeons, nurses, anesthesiologists, pharmacists, etc.) to the protocol has been imperative toward achieving the overarching goals of the ENERGY project.

Learn more about MBSAQIP

AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR)

Ongoing

A safe pain control initiative is now underway through the Agency for Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Surgical Care and Recovery (ISCR). Through this program, the ACS is working with hundreds of hospitals across the United States to bring standardized evidence based clinical pathways that prioritize multimodal, narcotic sparing analgesia to colorectal and orthopedic surgical patients. Future plans are to expand to additional surgical areas over the next few years. This approach provides an effective framework to eliminate many of the perioperative-related drivers of the opioid crisis while also increasing value, reducing perioperative complications ,and improving the patient experience across many surgical procedures.

Perioperative providers have a played a role in the promulgation of the opioid crisis through their management of postsurgical pain. Large retrospective studies reveal that between 3 and 7 percent of previously opioid naïve patients undergoing operations continued to take opioids years later.* It is increasingly recognized that this exposure can be curbed by promoting the use of non-narcotic analgesic approaches, realistic expectations about perioperative pain and pain management, and judicious and limited use of narcotic analgesics once patients are discharged from the hospital.

Enhanced recovery pathways are a standardized evidence-based approach to perioperative care that emphasize collaborative multidisciplinary care with a focus on multimodal non-narcotic analgesia, and  patient and family engagement among  other evidence-based best practices. For more information on this national collaborative, visit: quality-programs/iscr

Learn more about ISCR


*Stone, AB, Wick, EC, Wu C.L et al. The US Opioid Crisis: A Role for Enhanced Recovery After Surgery. The Open Mind. International Anesthesia Research Society, Nov. 2017, Vol. 125, No. 5.