Date of Graduation

Summer 8-5-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

Section I: Abstract

Problem: Thirty percent of patients who have ambulatory surgery describe their pain as moderate to severe on postoperative phone calls in this Northern California Hospital. Patients have expressed dissatisfaction on the topic of subsequent pain on the Outpatient and Ambulatory Surgery-Consumer Assessment of Healthcare Providers and Systems surveys. Patients receive pain management education after recovery via oral and written format, but the content is not standardized. The aim of this project is to decrease the pain experienced by patients from 30% to less than 25% with a secondary goal to increase patient satisfaction with pain education from 10th % to over 20% on OAS-CAHPS.

Context: The recovery room has over fifty patient care bays. An average of 25 outpatient surgeries are performed a day. The vast majority of surgeries performed are same day discharge with an average recovery time of ninety minutes. Staff members deliver discharge instructions written by the surgeon which includes pain management. There is variability in content and delivery of pain management education. Unit stakeholders support an educational quality improvement project to address the patient’s needs for better pain control and satisfaction with their instructions.

Interventions: The American College of Surgeons Safe and Effective Pain Control After Surgery brochure was used to manage the content and delivery of educational material patients received to assess their pain and treat it at home. The brochure meets the Joint Commission requirements of 2018 related to pain education upon discharge (Joint Commission,2017). Inclusion criteria for the intervention group were adult English-speaking patients having scheduled elective surgery with exclusion of eye, ear/nose/throat surgery, add-on cases, and dementia. Staff engagement and buy-in was established with huddles sharing OAS-CAHPS scores and patient postoperative call verbatims. The brochure was presented in the preoperative period for patient to read, and it was reviewed in greater detail in the recovery phase before discharge. A pain score education flyer was added to help patients describe their pain to the nurse on the postoperative call.

Measures: Process measures included, increasing the amount of postoperative calls performed, auditing of nursing staff educating with the brochure, and auditing of documentation in electronic medical record. The unit informaticist pulled data from the electronic medical record to support audit accuracy. The two outcome measures included pain statements from the 24- hour postoperative phone calls and the OAS-CAHPS score on the question of subsequent pain delivered by the patient care experience coordinator.

Results: The outcome measure results as of June 11,2020 show that although the quantity of patients that complained of moderate to severe pain went down from 30% to 27%. The change was not statistically significant. At the time of this analysis, the OAS-CAHPS score regarding subsequent pain education showed improvement from 10% to 49% for March. Preliminary results for April sit at 46% and May at 99%.

Conclusion: There were extenuating circumstances that were in effect at the roll-out of this project. Covid-19 became a global pandemic. The volume of cases went down significantly from the average 25 cases a day to less than 10 a day. Workflows and priorities changed within the unit with a focus on infection control and safety. Based on the results of this project, the pain management educational brochure will be part of every patient’s discharge instruction packet pending funding approval. Studies have found that the more education the patient receives about their pain management at home the better they do. They have less complications, report less postoperative pain, and have a better surgical care experience (Sawhney,Wilson,&McGillion,2017).

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