The patient is referred with underlying spasticity, gait disturbance or dystonia, warranting trial of intrathecal baclofen for control.
Clinical screening will be done by neurology. Patient deemed a candidate for baclofen trial, then referral to neurosurgery.
Preapproval for the trial will be obtained through the neurosurgeon's office if consulted. Otherwise, preapproval will be obtained through the referring physician's office.
The referrals will be sent to Pain Care at Brighton Medical Center. All adult baclofen trials will be done at Brighton Medical Center through the Pain Care Unit with the exceptions to extraordinary circumstances. Bonnie or Alisha (Pain Care) will setup the trial date and notify the referring physician's office of the dates.
Organization of the dates for physician evaluation of trial and physical therapist contact will be handled by the referring physician's office.
The referring physician's office will be responsible for booking the patient as an outpatient in Day Surgery (exception NERH patient). Pain Care will book the procedure and observation times through central service and notifies the physical therapist of the date and time.
The referring physician will assume responsibility for patient/family education and information concerning the baclofen trial and associated risks. (attached is the information sheet for patients) The Anesthesiologist will be responsible for informing the patient/family of potential risks associated with a baclofen injection and obtain patient consent for trial.
Pain Care will notify the pharmacy of drug needs for the baclofen trial.
Pain Care will be responsible for notifying the patient and their family of the trial date and the pre-op information (NPO after 2400 and to take their medications). The referring physician will also be responsible for admit and discharge orders.
The baclofen trials will be done on Tuesday and Wednesday AM as an outpatient. They will have a total of 8 hours of observation time in Post-op Care with monitoring VS and pulse oximetry. The referring physician will request the frequency of evaluation to be done by the physical therapist. The success or failure of the trial will be the responsibility of the referring physician and the physical therapist.
The pain physician will be responsible for post procedure orders and be available for care during the 8-hour post injection.
If response noted, the trial stops.
If no response is noted, then the referring physician will contact the pain clinic for a repeat trial.
The pain physician will be responsible for the patient's discharge; the referring physician will be responsible for the patient's admittance to the hospital if necessary.
The referring physician is responsible for contacting the neuro surgeon if the trail was a success.
Discharge criteria The patient is awake and alert. He or she has a return of normal physical capabilities which enable them (or their caregiver) ease in their ADL's. The patient, their family or caregiver is not hindered to return for a repeat trial if needed.
Admit criteria The patient is weak and/or their level of consciousness is altered by the trial. The patient will have difficulties with their ADL's. It will be a burden for the patient and family and/or caregiver to return for a repeat trial if needed.