Quality Nursing Care Improvement in Acute Pain Management of Postoperative Orthopaedic Patients at Ramathibodi Hospital

Monday, 22 July 2013

Pensri Lausawatchaikul, RN, MNS
Orawan Warapapong, RN, MA
Orthopedic Nursing Service Division, Department of Hospital, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Learning Objective 1: the learner will be able to learn about how to assess patientsí pain status, satisfaction, and quality of postoperative pain management.

Learning Objective 2: the learner will be able to learn about how to monitor and improve quality of postoperative pain management.

Purpose:  Effective pain management has been shown to promote earlier mobilization, adequate rest, reduced hospital stays and postoperative complications.   Clinical observations and outcome indicators indicated a need to improve pain management and patient satisfaction was decreased.  The purpose of this study was to assess patients’ pain status, satisfaction, and improve quality of postoperative pain management.

Method: The protocol was revised and target indicators were set.  Team strategies included staff education, pain assessment tool, patient education material, pain management process and documentation. Outcomes were analyzed including pain level, impact of pain (interferes with activities of daily living, sleeping and mental health), patient satisfaction and quality of nursing documentation. 

Result: A total of 60 patients were included in this study.  The majority was female (57.4%) with the mean age of  58.28 (SD=17.2).  The mean LOS was 5.55 (SD= 4.46).   Results showed that the subjects had experience moderate level of worst pain in postop-day-1-2 and low level of worst pain in postop-day-3. Pharmocological pain management were as follow: by IV-MO 74.1 %, epidural-MO 14.8 % and PCA 5.6 %. About 62 %  of patients use nonpharmacological technique and distraction technique by watching television was the most (31.1 %). However, 37.8 % of patients did not use nonpharmacological technique to reduce their pain. The majority (57.8%) rated the satisfaction of their pain management by nurses as good and 22.7 % as excellent.  The majority, 48.9 %, pain moderate interfere (score 4-6) with ADL, minimal interfere (score 1-3), 39.6 % and 42.0 % with sleep and mental health, respectively.

Conclusion: Patient information for pain assessment and pain management prior surgery is the key process for improving postoperative pain management. However, encourage patient to use individual specific prefer nonpharmacological technique is essential for better pain management and more patient satisfaction. Pain management should selected by care provider with patient.