Post-operative pain management in oral and maxillofacial surgery and the formulation of new electronic prescribing order sets

Background: Post-operative pain management is pivotal in the patients' experience of surgical treatment. Despite existing guidelines, patients’ feedback suggests there is room for improvement. The aim of this study is to develop multidisciplinary designed analgesia electronic prescribing (EP) order sets suitable for OMFS. This should provide a consistent approach and clarity in prescribing for the junior doctors and nurses. Methods: A retrospective case review of analgesia prescription in 100 consecutives OMFS inpatients was conducted. To create OMFS prescribing EP order sets, patterns were discussed in a series of multi-disciplinary meetings, with a junior doctor, pain nurse specialist, head and neck pharmacist and consultant anaesthetist. These were structured according to surgical procedure severity, patient co-morbidities and route of administration. Results: Our cohort consisted of 59 males and 41 females, age ranging 17–91 years. Procedures included trauma (32), oncology (22), orthognathic (9), dento-alveolar (17), TMJ (5), salivary gland (6), skin (2) and other surgeries (7). 51 were planned admissions, 40 emergencies and 9 day-cases. The majority of patients (83%) were ASA 1– 2.84% were prescribed paracetamol whilst inpatients, 52% NSAIDs, 78% a weak opioid and 80% a strong opioid. 6% required adjuvant medication. No patients were discharged on strong opioids. These findings led to the construction of eight order sets, the rationale is discussed in the paper. Conclusion: EP order sets can be used as adjunct to the standard approach for pain relief. Their use can be time effective, minimise human prescribing error and ultimately act as a useful guide for junior doctors and nurses when prescribing pain relief.