Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions

Figures & data

Figure 1. Steps to develop the VRT.

Figure 2. Introduction of VRT.

Table 1. VRT data elements and sources.

	Source(s)
Costs	Literature review and Key Opinion Leader input
Medication
Equipment
Professional costs for Placement
Placement
Monitoring
Ultrasound guidance
Infiltration
Transversus Abdominus   Plane Blocks
Opioid Related Adverse Event
Respiratory depression
Gastrointestinal   (nausea, vomiting, ileus)
Urinary retention
Central Nervous System   (somnolence, delirium)
Cutaneous (itching)
Adverse Event
Healthworker needle stick injury
Phlebitis
Bacteremia
IV Patient Controlled   Analgesia errors
Catheter dislodgement
Falls
Infection
Spinal cord injury
Post-operative urinary retention   (related to epidural)
Hypotension
Post-dural puncture headache
Re-admission
Length of Stay
Healthcare Provider Time
Nurse
Pharmacist
Pharmacy Technician
Nursing Impact	National Nursing  Survey (2014)
Level of Interference (Interferes to   Completely Interferes)
Job satisfaction in caring for   post-surgical patients
Time to complete and document   paperwork
Complete patient care on time
Manage patients equally and effectively
Patient Impact	Literature review
Pain Score
Time to discharge readiness  from PACU (h)
Patient satisfaction
Opioid use (mg equivalent)

Figure 3. Overall cost impact by procedure.

Figure 4. Nurse and patient impact.

Table 2. Cost per case by intervention (values in USD).

	Medication	Equipment	Placement	ORAEs	Adverse events	LOS	Re-admission	Healthcare providers time	Total cost
IV opioids using PCA device	143	121	115	90.65	146.13	9660	308	175.09	10,758.87
Continuous nerve block using  elastomeric pump	261	280.50	260.86	90.65	203.84	8820	220	140.95	10,277.80
Continuous wound infiltration  using elastomeric pump	261	259	239	90.65	70.68	8400	220	140.95	9681.28
Continuous epidural  using PCA device	135.88	154	225	90.65	28.20	9660	308	175.09	10,776.82
Liposomal bupivacaine	337.50	0.00	57.73	45.01	0.00	5460	88	80.70	6068.95

Figure 5. Cost to facility by PSMI.