Pain management—Continuum of care for surgical patients - Home Study Program

AORN Journal, Sept, 2003 by Sharon W. Chavis, Linda H. Duncan

In addition to assessment and determination of the comfort function goal, preoperative nurse educators and anesthesia care providers considered anxiety levels in discussions with patients. Risk factors and special needs are individually addressed during the preoperative interview process. For example, before the efforts of the PI team, diazepam was widely given preoperatively to a majority of patients. A change has resulted in diazepam now being administered based on individual need. Chart audits were performed again in January 2003. Overall, there has been a significant increase in documentation compliance relating to the six standards of measurement concerning pain assessment.

STAFF MEMBER EDUCATION. Staff members from each area specifically identified their own educational needs. This input was critical and yielded greater support and success and better outcomes. Staff members were educated about each redesigned form to ensure that a link existed between each area in surgical services to enhance the pain management continuum of care. Staff members completed mandatory education programs on pain management to increase their knowledge and competency levels. This was accomplished through various methods (eg, CD-ROM programs, videotapes, bulletin boards, staff meetings). The surgical services division of Centra Health elected to make January a pain management awareness month annually. The intent is to heighten awareness and stay abreast of changes in clinical practices regarding pain management.

PHYSICIAN STANDING ORDERS AND PROTOCOLS. After reviewing current clinical practices at both hospitals, team members strongly recommended developing postoperative phase I and II standing orders and protocols to better manage patients' pain and comfort levels (Tables 4 and 5). The goal was to have both anesthesia groups responsible for the management of patients' comfort and pain postoperatively to the point of discharge from the hospital. Each medical record would contain a preprinted standing order form that the anesthesia care providers could access easily.

Team members consulted with key champions from each anesthesia group. The outcome of these discussions was successful, and standardized anesthesia orders were formulated and approved between the two hospitals.

The orders were designed to allow anesthesia care providers to select medications from a preformatted standing order set appropriate to each patient based on procedure, medical history, anesthesia administered, and other medications given before arrival in the PACU. The standing orders also were expanded to include additional orders frequently required postoperatively (eg, oxygen, glucometers). This has been a great success and has affected response time to pain management and care of patients postoperatively. Medications are delivered in a more timely manner, and nurses are better able to control patients' pain so that comfort function goals are attained.

PHYSICIAN EDUCATION AND CLINICAL PRACTICE. The PI team also was interested in assisting and supporting physician education regarding pain management. An educational trifold form was constructed and placed in both facilities' OR physicians' lounges. The form displayed information regarding Centra Health's policy for pain management and changes in nursing documentation, including the approved pain scales to be used consistently throughout the Drganization. Additionally, data was shared specific to the medication utilization study. Data from the study included an analysis of the use of opioids, nonopioids, and antiemetics by surgeons and anesthesia care providers.