Monday, 18 November 2019: 1:15 PM
Purpose: Severe postoperative pain after Total Knee Arthroplasty (TKA) is a critical nursing concern. To achieving rapid recovery, pain must be adequately managed. Superior pain management and decrease hospitalization often lead to high levels of patient satisfaction. The purpose of this project is to the decreased length of stay (LOS), decrease the use of narcotic analgesics and improve patient’s satisfaction.
Background: Traditionally, TKA patients arrived in the surgical unit with a Patient Controlled Analgesia (PCA) for pain management. Before starting the innovation, patients with postoperative TKA experienced severe pain, requiring high levels of opiates & other narcotic analgesics. These patients remained on bed rest for an extended period due to the anesthetic effect. This affected the recovery process negatively and, which increased the period of hospitalization. Therefore, resulting in an adverse effect on the patient’s level of comfort as well as their overall satisfaction.
Keywords: Pain, length of stay, patient satisfaction
Methodology: A Plan-Do-Study-Act (PDSA) method for Quality improvement was used to evaluate whether this action-oriented change will improve and lead to a change.
Plan: Post-operative Knee Arthroplasty patients were experiencing severe pain with the traditional method of knee surgeries in the Post-Surgical unit (4C) at Dallas VA Medical Center. It was required to use a high amount of narcotic analgesics and opiates to control the pain adequately. Therefore; these patients remained on the bed that caused increased hospital LOS (>48 hours), increased usage of narcotic analgesics and decreased patient satisfaction scores.
Do: To attempting the Exparel (Bupivacaine Liposome Injectable Suspension) study on a small scale, a piloted study conducted for twenty cases initially. To evaluate the Exparel pilot study, created a planning meeting with the interdisciplinary team. Developed a group of designated nurses and provided training on treatment protocols, medication regimen, Polar ice, and ambulation standards. The post-operative ward nurses and management team to educate patients and families on pre and postoperative management under Exparel protocols developed patient Boot Camp.
Study: The Piloted study on 20 patients completed from November 2016 to February 2017. The most positive result of decreased LOS from >48 hours average to <24. The other outcomes include decreased opioid use by 96%; patient ambulation begins with 90 minutes after surgery. The overall patient satisfaction score improved by 100%.
Act: The actions continued to educating other staff members about the Exparel protocols and continually monitor the outcomes that include LOS, pain control, opioid use, and patient satisfaction scores.
Findings/outcomes: The qualitative data of direct interviews with patients indicated all the patients were extremely satisfied with their new knees. Overall benefits of Exparel resulted in decreased LOS <24 hours, decreased opioid use by 96%, patient ambulation begins with 90 minutes after surgery.
Summary: In summary, the Exparel medication has shown promise for TKA procedure. Therefore, the future consideration is to continue implementing the project to other VAs across the nation focusing decreased LOS, decrease the use of narcotic analgesics and improve patient’s satisfaction.
Background: Traditionally, TKA patients arrived in the surgical unit with a Patient Controlled Analgesia (PCA) for pain management. Before starting the innovation, patients with postoperative TKA experienced severe pain, requiring high levels of opiates & other narcotic analgesics. These patients remained on bed rest for an extended period due to the anesthetic effect. This affected the recovery process negatively and, which increased the period of hospitalization. Therefore, resulting in an adverse effect on the patient’s level of comfort as well as their overall satisfaction.
Keywords: Pain, length of stay, patient satisfaction
Methodology: A Plan-Do-Study-Act (PDSA) method for Quality improvement was used to evaluate whether this action-oriented change will improve and lead to a change.
Plan: Post-operative Knee Arthroplasty patients were experiencing severe pain with the traditional method of knee surgeries in the Post-Surgical unit (4C) at Dallas VA Medical Center. It was required to use a high amount of narcotic analgesics and opiates to control the pain adequately. Therefore; these patients remained on the bed that caused increased hospital LOS (>48 hours), increased usage of narcotic analgesics and decreased patient satisfaction scores.
Do: To attempting the Exparel (Bupivacaine Liposome Injectable Suspension) study on a small scale, a piloted study conducted for twenty cases initially. To evaluate the Exparel pilot study, created a planning meeting with the interdisciplinary team. Developed a group of designated nurses and provided training on treatment protocols, medication regimen, Polar ice, and ambulation standards. The post-operative ward nurses and management team to educate patients and families on pre and postoperative management under Exparel protocols developed patient Boot Camp.
Study: The Piloted study on 20 patients completed from November 2016 to February 2017. The most positive result of decreased LOS from >48 hours average to <24. The other outcomes include decreased opioid use by 96%; patient ambulation begins with 90 minutes after surgery. The overall patient satisfaction score improved by 100%.
Act: The actions continued to educating other staff members about the Exparel protocols and continually monitor the outcomes that include LOS, pain control, opioid use, and patient satisfaction scores.
Findings/outcomes: The qualitative data of direct interviews with patients indicated all the patients were extremely satisfied with their new knees. Overall benefits of Exparel resulted in decreased LOS <24 hours, decreased opioid use by 96%, patient ambulation begins with 90 minutes after surgery.
Summary: In summary, the Exparel medication has shown promise for TKA procedure. Therefore, the future consideration is to continue implementing the project to other VAs across the nation focusing decreased LOS, decrease the use of narcotic analgesics and improve patient’s satisfaction.