Pain and pain management in hospitalized patients before and after an intervention

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_j.sjpain.2016.11.006_s_007_w2aab2b8c56b1b7b1aab1c16b1Aa"><jats:title>Background and aim</jats:title><jats:p>Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.11.006_s_008_w2aab2b8c56b1b7b1aab1c16b2Aa"><jats:title>Methods</jats:title><jats:p>A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.11.006_s_009_w2aab2b8c56b1b7b1aab1c16b3Aa"><jats:title>Results</jats:title><jats:p>When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.11.006_s_010_w2aab2b8c56b1b7b1aab1c16b4Aa"><jats:title>Conclusions</jats:title><jats:p>This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.11.006_s_011_w2aab2b8c56b1b7b1aab1c16b5Aa"><jats:title>Implications</jats:title><jats:p>Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.</jats:p></jats:sec>

Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a “Hospital without Pain” certificate

“…Both nurses from the certified hospitals and those employed at noncertified centres had problems with defining minimal frequency and conditions of pain assessment in postoperative patients. Up to 45.8% of the study subjects were unaware of the fact that in line with current guidelines, pain should be assessed not only at rest but also under dynamic conditions, that is, during deep breathing, coughing (Tomaszek et al., ) and walking (Andersson et al., ; Chou et al., ; Sayers et al., ). Assessment of pain under dynamic conditions results in its better control, providing that nurses follow internal SOPs regarding administration of painkillers and the thresholds of pain at which the treatment needs to be implemented or modified (Tomaszek et al., ).…”

Comparative efficacy of continuous infusion of bupivacaine/fentanyl and ropivacaine/fentanyl for paediatric pain control after the Ravitch procedure and thoracotomy. A prospective randomized study

“…During the entire observation period, the nurses took pain measurements 5947 times, including 2214 (37.2%) at rest, 1912 (32.1%) during deep breathing and 1821 (30.6%) while coughing. There was no significant difference between the BF and the RF group in terms of the number of pain measurements at rest (Me: 22 [20][21][22][23][24][25] vs. 24 [21-26.5], Z = -1.285, P = 0.197), during deep breathing (Me: 20 [18][19][20][21][22] vs. 20.5 [17.5-22], Z = -0.239, P = 0.810) and coughing (Me: 20 [18][19][20][21] vs. 19.5 [17][18][19][20][21][22], Z = 0.234, P = 0.813). Table 2 provide descriptive statistics for pain intensity (mean, maximal).…”

“…It is well documented that inadequate pain control may delay recovery, increase morbidity and mortality, increase anxiety, decrease patient satisfaction, and lead to chronic persistent postsurgical pain 14,15 . Unfortunately, results of many studies conducted in different countries show that the treatment of postoperative pain in children is inadequate -too many children still experience intense pain [16][17][18][19][20][21] .…”

Establishing a pain management program in cardiology: what we can learn from social marketing and normalization process theory Implementation of pain management in cardiology

“…There is considerable literature dealing with pain management, ranging from pediatric (2) and geriatric care (3), to the managerial issues involved with pain management programs (4). Speci cally, the use of pain management guidelines for healthcare workers has been examined (5), as well as communications about pain management with patients following post-operative cardiac surgery (6). Establishing a pain management program (PMP) in a cardiology/electrophysiology (EP) department might seem unnecessary at rst glance because interventions are regarded as minimally invasive (7,8).…”