Oral Administration Prioritized Over Intravenous in the Operating Room: Insights from The Doctor’s Daily | Medical News

Oral Painkillers: A Sustainable Shift in Post-Operative care

Caen University Hospital in france is spearheading a significant change in post-operative patient care, moving away from intravenous pain medication to oral alternatives like tablets. This shift is yielding substantial environmental benefits and cost reductions, showcasing a simple yet impactful strategy for sustainable healthcare practices.

The Environmental Benefits of Going Oral

The transition to oral painkillers considerably minimizes the environmental footprint of medical procedures. According to Dr. Stéphanie deryckère,an anesthesiologist-resuscitator instrumental in launching this initiative,opting for oral governance versus intravenous treatment translates to “thirty times less greenhouse gases,seven times less water consumption,or a cost reduced by 17 or 19 depending on the establishment.” The initiative began in 2019 as part of the Green Bloc program, a collaborative effort led by Omedit and ARS Normandie.

The implemented protocol, endorsed and distributed by anap, France’s National Agency for the performance of health and medico-social establishments, centers around a combination of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). These are administered to adult patients undergoing short procedures, provided there are no contraindications to oral medication, both before and after surgery.

Quantifiable Results: Savings and Waste Reduction

Initial findings from Anap’s analysis reveal promising results. Between 2018 and 2020, Caen University Hospital saw a substantial decrease in the usage of intravenous medications. The number of NSAID ampoules ordered dropped from 2,328 to 1,225, while intravenous acetaminophen bags decreased from 4,502 to 2,700. This reduction translated into 800 kg less CO₂ equivalent emitted and 152 kg less waste generated. Furthermore, the hospital realized savings of 1,700 euros on medication costs.

A 2015 study published in The Lancet projected that switching 10% of global analgesic administration to oral methods could save 3,450 tonnes of waste annually from the 310 million surgeries performed worldwide.

streamlining Operations and Enhancing Patient Care

The reduction in the volume of medical supplies-bottles, tubing, infusers, and bags-has not only lowered waste but has also streamlined hospital logistics and freed up valuable storage space. Dr. Deryckère emphasizes, “Oral medication takes a hundred times less space than IV painkillers. It also avoids administration errors,saves preparation time and improves the quality of care: patients walk more quickly post-operatively as they are no longer connected to a tube.”

However, the transition isn’t without its challenges. Training healthcare staff and adapting existing workflows require time and dedication.

Overcoming Implementation Hurdles

while the benefits are clear, adopting the oral-first approach requires organizational adjustments. Nurses in high-turnover units may face increased workload preparing and dispensing tablets to each patient. Physicians also need to adjust prescribing habits during pre-operative consultations, and there may be initial compatibility issues with electronic health record systems. “Some software is still buggy”, admits Dr. Deryckère.

Despite these hurdles, the simplicity of the protocol, coupled with its ecological advantages, has proven highly motivating for healthcare teams. the success at Caen University Hospital is attributed to effective communication, managerial support, ongoing training, and strong institutional backing, with the hospital pharmacy proactively adjusting medication allocations.

Metric	2018	2020	Change
NSAID Ampoules Ordered	2,328	1,225	-47.1%
IV Acetaminophen Bags	4,502	2,700	-40.0%
CO₂ Equivalent Savings	N/A	800 kg	N/A
Waste Reduction	N/A	152 kg	N/A
Cost Savings	N/A	€1,700	N/A

This project aligns with the hospital’s broader ecological policy,contributing to both post-operative rehabilitation and reducing overall medical device consumption. Plans are currently underway to expand the initiative to other departments and potentially other healthcare facilities.

Dr. Deryckère underscores that this shift highlights a critical aspect of ecological transition in healthcare: “One of the grate battlehorses of the ecological transition in health is medicines and medicinal devices.This is where the greatest financial and ecological savings can be made.”

The Future of Sustainable Healthcare

The example set by Caen University hospital represents a growing trend towards sustainability within the healthcare industry. As concerns about environmental impact intensify and healthcare budgets tighten, hospitals are actively seeking innovative ways to reduce waste, lower costs, and improve patient outcomes simultaneously. Expect to see a wider adoption of oral medication protocols, alongside other eco-friendly practices.

Hospitals looking to implement similar protocols should focus on thorough staff training, streamlined workflows, and proactive collaboration between pharmacy, nursing, and physician teams.

Frequently Asked Questions about Oral Painkillers

What are your thoughts on the move towards more sustainable practices in healthcare? Share your opinions in the comments below!

How does prioritizing oral administration align wiht the principles of Enhanced Recovery After Surgery (ERAS) protocols?

The Shift Towards Oral Medications in Perioperative Care

For decades, the operating room (OR) surroundings has been synonymous with intravenous (IV) medication administration. However, a growing body of evidence and evolving clinical practice are demonstrating the benefits of prioritizing oral medication whenever clinically appropriate, even during and promptly following surgical procedures. This isn’t about replacing IVs entirely, but strategically utilizing oral routes to optimize patient outcomes, reduce complications, and streamline perioperative management. this article, drawing from observations in “The Doctor’s Daily,” explores this paradigm shift in perioperative medicine.

Why the Change? Examining the advantages of Oral Routes

The move towards oral drug delivery isn’t arbitrary. Several key advantages are driving this trend:

* Reduced Risk of Central Line-Associated Bloodstream Infections (CLABSIs): IV access, particularly central lines, carries inherent risks. Oral medications bypass this risk entirely.

* Improved Patient Comfort: Avoiding IV insertions and maintaining fluid balance without large volume infusions significantly enhances patient comfort. Patients frequently enough report less anxiety and a more positive experience.

* enhanced Gastrointestinal (GI) Function: Maintaining oral intake, when possible, supports normal GI motility and function, crucial for post-operative recovery. Prolonged NPO (nothing by mouth) status can lead to ileus and delayed discharge.

* Cost-Effectiveness: Oral medications are generally less expensive than their IV counterparts.

* Simplified Administration: Oral administration often requires less specialized nursing time compared to IV management.

Specific Medications Seeing Increased Oral Use in the OR Setting

While not all medications are suitable for oral administration in the perioperative period, several are increasingly being utilized:

* Anti-Emetics: Oral anti-emetics, like ondansetron, are frequently used for post-operative nausea and vomiting (PONV) prophylaxis and treatment.

* Analgesics: Oral pain medications, including acetaminophen and NSAIDs, are frequently enough sufficient for managing mild to moderate post-operative pain. Opioid-sparing analgesia strategies are a key focus.

* Antibiotics: For certain elective surgeries with a low risk of infection, oral antibiotics are being considered as a viable alternative to IV antibiotics, particularly for prophylaxis. This requires careful patient selection and adherence to established protocols.

* Oral Nutritional supplements (ONS): Pre-operative ONS are increasingly used to improve nutritional status and reduce post-operative complications.

Challenges and Considerations for Oral Administration

Implementing a strategy prioritizing oral administration isn’t without its challenges:

* Patient Compliance: Ensuring patients can and will take their medications orally is crucial. Factors like nausea, difficulty swallowing, or cognitive impairment can hinder compliance.

* Gastric Emptying Time: Delayed gastric emptying, common after surgery, can affect the absorption of oral medications.

* Drug Bioavailability: Oral bioavailability can vary significantly between medications. Higher doses might potentially be required to achieve equivalent effects compared to IV administration.

* Specific Surgical Procedures: Certain procedures, such as those involving the gastrointestinal tract, may preclude oral intake for a prolonged period.

* Emergency Situations: IV access remains essential for rapid drug delivery in emergency situations.

The Role of enhanced Recovery After Surgery (ERAS) Protocols

The shift towards oral administration is deeply intertwined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols. ERAS protocols are evidence-based, multimodal approaches to perioperative care designed to minimize physiological stress, reduce complications, and accelerate recovery. Key ERAS components that support oral medication use include:

* Pre-operative Carbohydrate Loading: Improves insulin sensitivity and reduces post-operative stress.

* Minimally Invasive Surgery: Associated with less pain, reduced inflammation, and faster recovery.

* Multimodal Analgesia: Utilizing a combination of pain medications, including oral options, to minimize opioid use.

* Early Oral Feeding: Encouraging patients to resume oral intake as soon as possible after surgery.

Case Study: Laparoscopic Cholecystectomy and Oral Analgesia

A recent case at our institution involved a 52-year-old female undergoing laparoscopic cholecystectomy. Following the procedure, rather of relying solely on IV opioids, the patient was transitioned to a regimen of oral acetaminophen, ibuprofen, and a small dose of oral gabapentin for pain management.She tolerated the oral medications well, reported adequate pain control, and was discharged home 24