Ambulatory pain management program: A step toward the future


At St. Joseph’s Health Care London, a new ambulatory program enables patients to go home sooner with the help of a pump to manage post-surgical pain. An interdisciplinary team that included an anesthesiologist, advanced practice nurses, a pharmacist, nursing leaders, occupational therapists, and community nurses developed the ambulatory regional anesthesia/analgesia discharge program. Patients are discharged with a small indwelling catheter, positioned near a group of nerves that allows for a continuous infusion of local anesthetic.

“We wanted to send patients home with a better pain management plan,” says Kim Horrill, nurse practitioner/clinical nurse specialist in pain management. “We believe ours is one of the first comprehensive, multidisciplinary programs of its kind in Canada, providing seamless care from pre-admission to discontinuation of therapy.”

The vision for the program came from anesthesiologist Dr. Kevin Armstrong, who has a keen interest in regional anesthesia, and from Kim, who saw an opportunity for improved pain management upon discharge.

While the program was designed for patients having upper extremity orthopedic surgeries – shoulder arthoplasties, rotator cuff and elbow contracture releases – Margo Bettger-Hahn, clinical nurse specialist for upper limb orthopedics and plastic surgery, says they have quickly seen that other upper extremity surgeries may also benefit.

Until now, pain management has kept these patients in hospital, with an average stay of two nights. Now, with the new portable infusion pumps that fit in a fanny pack, these patients can go home to recuperate and resume many of their daily activities.

Nursing staff have been instrumental in providing the education to the patients and families to ensure a smooth transition from hospital to home.

Linking with external partners

The program is comprehensive and addresses the continuum of care in that it includes home follow-up visits by a VON (Victorian Order of Nurses) nurse.

St. Joseph’s works closely with hospital case managers at Community Care Access Centre of London & Middlesex to ensure these patients receive appropriate care at home. This expansion of its home services was made after first ensuring that:

  • nursing staff with the required skills and abilities were in the community;
  • a sufficient number of referrals for nurses to maintain that expertise would occur;
  • a back-up system was in place for nurses and clients;
  • this change in care presented an advantage to the patients and health-care providers.


Jill Bishop, a registered nurse with expertise in regional analgesia/anesthesia, Kim, and Margo, worked with the pump manufacturer to provide the necessary training for hospital nursing staff, (those who would see patients during their immediate post-operative recovery), and community nursing staff, (those who care for patients in their homes).

A ‘Train the Trainer’ approach allowed staff who attended the primary sessions to pass their learning along to co-workers, and in turn to patients and their families.

Program evaluation

Surveys to date show patients are very pleased with the program:

  • 68 per cent rated the block excellent for managing pain
  • 34 per cent rated it as good
  • 92 per cent would choose to have another block at home for managing pain
  • 92 per cent would recommend this to family or friends