Date of Graduation

Summer 8-8-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

Problem: Cesarean sections (C/S) are among the most common operations in the United States and result in moderate visceral and somatic pain. Historically, C/S pain has been treated with opioid pain relievers. The U.S. Department of Health and Human Services declared the misuse of opioids an epidemic in 2017, leading healthcare providers and organizations to look inward at how opioids are prescribed and used at all levels of patient care.

Context: A microsystem assessment on a 60-bed mother/baby unit indicated one of the highest average opioid administration rates per day for postoperative C/S patients in the organization’s region for the obstetrical service line.

Interventions: A quality improvement project was implemented to address this problem. Based on an extensive literature review, a quality improvement team established a proposal for three interventions to decrease the average opioid use per day in this patient population. All interventions were non-pharmacological. The first was an abdominal binder that all C/S patients received upon arrival at the mother/baby unit. The second was increased use of simethicone for postoperative gas pain. The third intervention was a pain management menu to guide nurses in providing postoperative pain management education. Due to the time constraints of the project, the quality improvement team did not implement the interventions of increasing simethicone use and the use of the pain management menu.

Measures: The outcome measure was the average morphine equivalents per day administered postoperatively. The process measures included the rate of patients who received abdominal binders postoperatively, the rate of patients who received simethicone during their postpartum stays, and the rate of patients who received pain management menus. The balancing measure was the daily average delta pain score.

Results: Data from June 2021 showed a 0.6 morphine equivalent decrease in the average daily morphine equivalent administration rate. Abdominal binder applications increased from 57% to 86%, and the percentage of patients who did not receive a binder decreased from 43% to 14%. Average delta pain scores dropped 0.2 points, indicating patients did not verbalize additional pain following interventions.

Conclusion: Maternity healthcare providers are responsible for adequately treating and managing postoperative pain to optimize recovery and encourage bonding of the new family unit. The use of non-pharmacological interventions can decrease pain without the undesirable side effects seen with opioid administration. Initial results showed a decrease in the administration of opioids postoperatively by increasing abdominal binder use among C/S patients. Further data will need to be collected to determine the long-term benefits of the interventions implemented.

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