Pain Injection Procedures for ASCs: Insights and Best Practices

Setting Up Pain Injection Procedures

To set up a pain injection program at an ASC, begin by consulting with the orthopedic and/or anesthesia team performing the procedures. Securing the right equipment, medications and supplies is next. It is also crucial to establish protocols and policies and procedures for admission criterion, pre-op assessments, post-operative rides, tracking complications and all other necessary quality measures.

Sedation and Recovery

Pain injections may be performed under conscious sedation, although many payers including Medicare do not pay separately for anesthesia services provided for these cases. Patients are kept in the center until they return to their baseline, which usually takes about 30 minutes. Whether anesthesia is given or not, it is require for patients to have an adult take them home after the procedure.

Post-Operative Monitoring

Patients should be monitored post-operatively until their vital signs return to baseline and all discharge instructions should be given in a format best suited for each patient. Complications should be tracked like any other surgical procedure, using monthly infection control surveys sent to physicians.

Local Anesthesia Considerations

For cases performed under local anesthesia only, obtaining two sets of vitals intra-operatively and one set of vitals in the Post Anesthesia Care Unit (PACU) is recommended. Further monitoring might be necessary if the patient did not tolerate the procedure well. They usually have a shorter stay in the post-operative area, but will still need to ambulate at pre-procedure level and meet discharge criteria.

Nurse Training and Competency

When RNs are responsible for administering IV conscious sedation, initial and annual competency check-offs should be performed. The Medical Director or an anesthesiologist/CRNA should sign off on the RN’s competency in accordance to your centers Policies and Procedures, to ensure they can appropriately administer and monitor conscious sedation patients.

Reimbursement Concerns

In general, ASCs have typically not encountered reimbursement issues for pain management injections. However, it is essential to stay informed about any changes in reimbursement policies that may affect the procedures performed in an ASC setting.

Conclusion

Implementing pain injection procedures in an ASC requires careful planning, coordination with all team members, and adherence to best practices for patient care and safety. By taking these steps, ASCs can successfully offer pain management injections as a valuable service to their patients and providers.