Pain Management in the Post Surgical Patient: It Is Not All about Narcotics

In response to the growing concern over patient safety, quality, and health care outcomes, the Clinical Nurse Leader (CNL) role was created. As the health care environment changes, it is critical that nurse leaders build upon the foundation of clinical expertise utilizing the CNL skill set in a variety of roles. The influence of the CNL on an acute care floor has created an environment of continual improvement.  The staff, on the acute care trauma unit, at a large academic medical center, are constantly looking for opportunities to improve care delivery.  Pain Management is always a challenge with the post traumatic and burn patients the unit serves.  The purpose of this presentation is to describe how, a new leader on the unit identified a need to improve how nursing staff addressed pain management on this post-surgical, traumatic, burn, unit.  The assistant nurse manager identified quickly an opportunity to improve how well patient’s pain was managed on the unit.  She had reviewed the literature and evaluated our current practice only to recognize that the staff was doing minimal interventions to address pain.  Yes, narcotics were being administered on time but could we not do more?  , The lack of knowledge of non-pharmacological interventions to minimize pain was evident. The Assistant nurse manager and other passionate staff nurses created a curriculum to educate the staff on interventions to alleviate pain other than solely with narcotics.  This curriculum included specific competencies, procedures, and experiences to be completed by licensed and non-licensed staff.  The curriculum continues to be revised based on staff feedback.  As the level of clinical expertise has vastly grown on the unit, the entire trauma service now is looking for innovative ways to optimize the nurse’s influence across the entire service to improve pain management of their patients

 The non-pharmacologic (no narcotic) menu provided to patients has decreased the total number of additional consults related to pain management, decreased the amount of narcotic consumed during hospitalization, and has greatly improved the patient’s perception of how their pain has been managed in the inpatient setting, post operatively.