pancreatitis, pain & guidelines - stapg€¦ · acute pancreatitis moynihan b ann surg. 1925...
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Pancreatitis, pain & guidelines
Derek O’ReillyConsultant HPB Surgeon – Manchester Royal Infirmary
MAHSC Honorary Clinical Professor – University of Manchester
South Thames Acute Pain ConferenceBrighton, 8 November 2018
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Acute Pancreatitis: a consideration of pancreatic hemorrhage, hemorrhagic, suppurative and gangrenous pancreatitis and of disseminated fat necrosis
”...three were distinctly intemperate, two may be regarded as gluttonous and one was exposed to hard work and extra hours”.
Fitz RH Boston Med Surg J 1889;120:181-7, 205-7, 229-35.
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Acute Pancreatitis
Moynihan B Ann Surg. 1925 Jan;81(1):132-42.
“Acute pancreatitis is the most terrible of all the calamities …the suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it, all render it the most formidable of catastrophies.”
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Chronic relapsing pancreatitis; a study of 29 cases without associated disease of the biliary or gastrointestinal tract
“Attacks were prone to follow lifting, moderate exercise or yelling. His mother stated that he always had an attack if he ate pancakes…68 % were due to alcohol”
Comfort MW. Gastroenterology 1946;6:376-408
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Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15.
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National Confidential Enquiry on Patient Outcome and Death (NCEPOD)
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Prof Derek O’ReillyConsultant HPB Surgeon, Manchester Royal InfirmarySurgical Clinical Coordinator, NCEPOD
https://www.ncepod.org.uk/2016ap.html
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Study aim
To identify remediable factors in the
quality of care provided to patients
treated for acute pancreatitis
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Study population inclusion criteria
Patients aged 16 years or older who were coded for a primary diagnosis of acute pancreatitis and admitted to hospital between 1st January and 30th June 2014
• An inpatient stay of three or more nights
• Admission to critical care
• Death in hospital
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Data collection
• Clinician questionnaire
• Case notes/peer review
• Organisational questionnaire
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Data returns
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PAIN MANAGEMENT
Core Standards for Pain Management Services in the UK. 2015 www.rcoa.ac.uk/system/files/FPM-CSPMS-UK2015.pdf
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Acute pain teams
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Acute pain teams 24/7
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Specialist acute pain nurse
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Consultant lead
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Pain score on admission
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Pain management
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Acute pain team
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Pain management
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Lessons from a national audit of Acute Pancreatitis: a summary of the NCEPOD report 'Treat the Cause'
D A O’Reilly et al. Pancreatology 2017;17:329-333.
Antibiotic overuse Gallstones not treated Opportunities for improvement
Antibiotics were prescribed in 439/712 (61%) of patients
Gallstones were the cause of 40/132 recurrent admissions
Room for improvement in 52% of cases
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Outcomes of hospital episode
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Overall quality of care
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Conclusion
Much good news
But the full picture is more complex; there are many areas where we could be doing better
NCEPOD has identified these and produced recommendations for improvement