Paper: Implementing an Orthopaedic Pain Management Process in an Acute Care Setting (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Tuesday, 8 July 2008: 10:50 AM

Mary E. Hardwick, MSN, RN , Shiley Center for Orthopaedic Research & Education, Scripps Clinc, La Jolla, CA

Pamela A. Pulido, RN, BSN , Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Clinic, La Jolla, CA

Learning Objective 1: The learner will be able to identify 2 steps in the process of changing total joint arthroplasty pain management in a multidisciplinary setting.

Learning Objective 2: The learner will be able to verbalize the outcome of instituting an orthopaedic pain management protocol.

Assessing and treating patient's pain after total joint replacement (TJR) surgery is an important part of patient care. Declining patient pain satisfaction on benchmark data was a concern. We, therefore, examined pain management of our TJR patients using evidence-based practice model and assessed our patient's and staff's perceptions and practices of pain management using IRB-approved questionnaires.

Pain management issues identified included lack of formal process to facilitate communication, staff perception of poor pain control, lack of standardization of postoperative pain orders, ineffective pain medication orders, and frequent calls for pain management orders.

Changes implemented included development of Orthopaedic Pain Committee (acute care nurses, research and outpatient nurses, physicians, anesthesia, pharmacy), implementation of innovative standardized orthopaedic postsurgical analgesic and antiemetic orders, increased staff pain management education, and enhanced patient preoperative pain education. We developed and administered IRB approved baseline and post-implementation staff survey and patient survey.

Patient satisfaction after implementation of the standardized orders indicated 13% increase, a decrease in reported pain score, a decrease in narcotic usage, and an increase in patients who received pain management information preoperatively. Staff survey after implementation of the standardized orders indicated decreased calls for pain issues and 22% increase in use of oral medication as first choice in pain management. Because of staff education, 62% of staff reported their pain management practices changed and 67% reported increased awareness of pain management and narcotic side effects.

Future plans include quarterly staff pain management classes, incorporation of pain management into outpatient education classes, and continued patient pain survey as part of our database. We used evidence-based practice to institute a standardized orders, which increased patient satisfaction, provided better pain relief for patients, increased patient and staff education on pain management, and provided staff with a comprehensive tool they can use to improve patient outcomes.

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