Meet with patient and any others involved with patient.
Establish (as close as possible) dosage, frequency of analgesic(s) to be used.
Establish duration of each dosage and frequency schedule (i.e. establish an appropriate taper schedule) based on physician’s experience and patient’s expected reasonable needs.
Involve anesthesiologist in planning pre- and post-operative care (use a recovering one if possible).
Emphasize NO PRN medication except in unusual, unexpected, or exceptional circumstance (e.g. dressing change in burn injury patient.)
If possible do not discharge on any mood altering medication (s); however, if care management coordinator requires you do this.
Patient does NOT dispense their medication.
A mutually acceptable responsible person (determined pre-operatively) dispenses medications only on schedule - NO PRN MEDS — Must be very firm.
Switch to non-mood altering medication(s) ASAP
Arrange for someone (e.g. AA/NA sponsor, Alanon family member, AA/NA group member) to stay with patient (try to arrange for suspension of hospital visiting rules).
Caveats
Many liquid medications contain alcohol unless labeled or ordered otherwise.
Plan ahead-most operative procedures are elective (even open heart)
Use local anesthesia when possible (e.g. MARCAN infiltrated into surgical wound site to decrease P/O pain.).
Increase 12-step meetings pre- and post-operation.
Use PCA only with the greatest of reservations if at all.
Use regional anesthesia whenever possible.
Any outpatient prescription pain medications: only exact number needed (e.g. QID x 3 days — dispense only 12). No refills.
For more information contact The American Chronic Pain Association at ACPA
