Transforming Ambulatory Care through Patient-Centered Pain Management in Minimally Invasive Procedures

Purpose: The evolving landscape of ambulatory care is witnessing an influx of patients with higher acuity needs. Resource limitations pose challenges in delivering comprehensive care, as outpatient procedures become more commonplace and the demand for enhanced patient support during these interventions has intensified. Non-licensed clinics within our healthcare facility have pioneered the shift of certain procedures from surgery settings to ambulatory care. To ensure the maintenance of high-quality care, addressing patients’ needs, including pain and anxiety management and safe post-procedure discharge, has become imperative.

Description: In response to the growing need for improved patient experience, an innovative strategy has been developed – the utilization of patient self-administered 50:50 nitrous oxide and oxygen during minimally-invasive procedures. This practice, well-established globally and commonly used in dental offices, birthing centers, and even veterinary clinics, has demonstrated efficacy in managing pain during outpatient procedures.

Implementation process: A multidisciplinary workgroup, comprising representatives from ambulatory care nursing, safety department, pharmacy, information services and solutions, clinical epidemiology and infection prevention, and physician leadership, collaborated to create a comprehensive policy, devise a staff training program, and integrate the physician order into the electronic health record. The primary objective is to educate patients on self-administering a 50:50 mixture of nitrous oxide and oxygen, ensuring patient comfort, minimizing nitrous oxide exposure to staff, and facilitating safe post-procedure discharges.

Policy implementation and training: The policy was approved by the ambulatory care policy committee and implemented in April 2023. Ambulatory care nursing conducted staff training, covering equipment setup, equipment disinfection, and utilization of iMed consent embedded in the electronic health record.

Evaluation/outcomes: To assess the impact of this innovative approach, various metrics were measured, including the utilization of the nitrous oxide system, patient feedback on its efficacy, and the effectiveness of a scavenger system for nitrous oxide disposal to reduce staff exposure. These metrics serve as crucial indicators of the success and sustainability of the implemented strategy. This presentation highlights the journey of implementing patient self-administered 50:50 nitrous oxide and oxygen in ambulatory care for minimally invasive procedures. By fostering collaboration across disciplines, creating comprehensive policies, and implementing robust training programs, our initiative aims to enhance patient care, mitigate staff exposure, and set a precedent for innovative pain management strategies in ambulatory settings. The measured metrics provide valuable insights into the effectiveness and safety of this approach, contributing to the ongoing evolution of ambulatory care practices. This approach offers significant advantages, such as high patient acceptance and successful pain management.