Communication with Primary Care Providers is recommended when discharging a patient on opioids especially modified release (MR ) preparations (which should generally be avoided in acute pain management).55
There should be clear discussion with all patients started on opioids, especially MR preparations, on the risks of opioids with a clear agreed and documented plan to de-escalate and stop them when the acute pain phase is over.78
The service should have access to Chronic Pain Outpatient Clinics that specialise in opioid de-escalation.58
Guidelines for the management of specific patients groups (as listed in 3.6) should be available.
Pain and its management should be regularly recorded in the patient notes and/or observation chart using validated tools for each clinical setting. Consistent tools should be used throughout the patient pathway.70
Equipment, protocols and training should be in place to allow the safe delivery of continuous regional analgesia. Post-operative pain scores and function may be improved by the use of continuous regional analgesia after appropriate procedures.59
Inpatient pain services (IPS) should be staffed by multidisciplinary teams led by appropriately trained consultant or SAS anaesthetists. The minimum training requirement for new appointments to IPS lead roles is Royal College of Anaesthetists higher pain training.32 Advanced pain training, or its equivalent, should be considered optimal.
Anaesthetists in an IPS post need to demonstrate an ongoing significant interest in acute pain management by involvement in continuing professional development (CPD), appraisal and job planning.
Adequate time should be made available for IPS provision in job plans. Two clinical sessions for the lead(s) and one session for all other anaesthetists involved in the IPS is recommended per week.
Adequate staff and systems should be in place to provide timely pain management to all inpatients. Out of usual working hours, this may be delivered by appropriately trained IPS nursing staff or anaesthetic staff (having received intermediate pain training as a minimum standard). A clear point of contact for expert advice should be available at all times.
