1. Clement, Mary Ann

Article Content


Pain management (the fifth vital sign) is an ongoing concern in medicine today. Nurses and physicians play an important role and responsibility in pain assessment, pain intervention, monitoring the effects of treatment, and communicating information about the patient's pain. The CNS and staff nurses noticed a varied use of adjunct postoperative pain medication. The CNS discussed this observation with the Pharmacy and Therapeutic Committee and the plan to conduct a medication use evaluation (MUE) with in health system as formulated.



To provide education to the nursing and physician staff on the advantages and disadvantages of ketorolac IV with morphine IV to control postoperative pain.



The CNS identified postsurgical care unit (PSCU) patients who received concomitant ketorolac and morphine and found that they were out of bed sooner, had better pain control, had less opioid side effects, and were discharged sooner. The literature review supports these outcomes.


Description of Practice Change

The CNS worked with the Pharmacy and Therapeutic Committee to begin a an MUE owing to the varied use of ketorolac. The pharmacy began a retrospective data collection of its usage. The results will be reviewed and further recommendations presented.



Ketorolac use guidelines will be developed and made available to the CNS and physicians. This information will be displayed on a poster board. The CNS and staff nurses will perform unit monitoring on ketorolac usage with morphine. The pharmacy will then plan to repeat the MUE.



Ketorolac IV can be an effective adjunct to morphine IV in the appropriate patient to manage short-term postoperative pain. The benefits of having the patient pain-free become apparent. This was a multidisciplinary approach to improve quality care and patient outcomes.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.