A small postoperative change in how patients who have undergone bariatric surgery at the University of Florida are treated has produced improvements in comfort and safety, highlighting the Department of Surgery’s emphasis on constant quality improvement.
Launched last fall, a quality project that focused on replacing liquid acetaminophen with powder packets has cut medication intolerance by almost two-thirds and showed how small, patient-driven ideas can ripple through an academic hospital.
Bariatric procedures such as sleeve gastrectomy or Roux-en-Y gastric bypass dramatically reduce stomach size. When paired with postoperative swelling, patients are left with an inability to tolerate more than tiny amounts of liquid as they recover from the weight loss surgery.
Gwendolyn Crispell, M.S.N, R.N., C.B.N., a metabolic and bariatric nurse coordinator, heard the same patient complaints again and again: the liquid form of acetaminophen, given 20 CCs at a time, was too much to handle. Some couldn’t get it down at all. Others would throw up shortly afterward.
“It’s a pretty big volume for somebody just coming out of bariatric surgery,” Crispell said. “One of my patients asked me if I’d ever heard of acetaminophen dissolve packets. I hadn’t, but I always learn from my patients; I looked into it and it seemed like an idea worth exploring.”
Changing the medications available to patients is anything but simple. Crispell worked with an inpatient pharmacist , Zachary Johnson, PharmD, BCPS to develop a comprehensive proposal.
“It may still be acetaminophen, but we had to go through several committees, get approval, buy-in from the surgeons and so on,” Crispell said. “Eventually we were given exclusive approval to give the dissolving packets to our patient population.”
Crystal Johnson-Mann, M.D., M.P.H., an assistant professor, a minimally invasive and bariatric surgeon and the interim metabolic and bariatric surgery program director in the UF Department of Surgery, said her team already knew liquid acetaminophen was problematic.
“Our patients were sometimes throwing up water and protein shakes,” she said, “but we were seeing that liquid acetaminophen was more often the culprit.”
But when exploring options for improvement, Johnson-Mann said giving patients acetaminophen intravenously wasn’t a good alternative to oral medication.
“We don’t want patients dependent on an IV for pain control,” she said. “They can’t do that at home and it prolongs length of stay.”
The dissolvable packets were a promising solution because they drastically reduce the volume a patient needs to consume to take the medication, since the powder dissolves on the tongue and allows patients to get home quicker and continue effectively treating postoperative pain.
The results were clear. Although the team only aimed for a 20% increase in tolerance, it improved by 62%. Average patient pain scores also showed improvement in the same period of time.
Johnson-Mann credits the project’s success to Crispell’s leadership and the excellent nurses who care for patients who undergo bariatric surgery.
By trusting patient feedback and observing patterns, UF Health’s bariatric team found a way to turn a small change into a big win.
“Quality projects aren’t always about big problems like surgical site infections or bleeding,” Johnson-Mann said. “It could be something straightforward like nausea or pain. The important thing is that recognizing a pattern is an opportunity to create or design something that leads to better outcomes for patients.”