Methods: A retrospective record review pre and post a practice change intervention evaluated implementation of a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis was used to compare patient reports of pain control and patient satisfaction with care 48 hours post-discharge from outpatient surgical procedures. Feasibility of data collection and measurement issues were also explored.
Results: 231 records (98 pre-intervention; 133 post-intervention) were analyzed. The sample included 144 (62%) male and 156 (68%) married with mean age 57.6 (SD=16.1) years. The large majority (90%) received general anesthesia and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the post intervention group (Mean rank=62.66) than for the pre-intervention group (Mean Rank = 51.95), U=1258, p=0.015. A large number of missing data related to the standard of care post-op phone calls (54% missing) and receipt of the intervention (47% receiving the script at time two).
Conclusion: While it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues related to data collection and intervention fidelity will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Overcoming resistance to change when evidence is not robust is challenging and may be especially difficult related to scripting, which is often perceived as a mandated intrusion into the nurse-patient relationship.