Patient and nurse assessment of quality of care in postoperative pain management

Abstract

Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments. Design: Patient and nurse questionnaires. Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden. Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments. Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire. Results: The patients' mean (SD) score on the total scale (scale range 14-70) was 58.6 (8.9) and the nurses' mean (SD) score (scale range 12-60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients' experience of worst possible pain intensity. Conclusion:The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management. R easons for measuring the quality of care include obtaining more detailed information about patient care, determining whether standards are being achieved, identifying potential areas for improvement, and informing purchasers and thereby securing resources for future services. Good quality of care is considered to be the right of all patients and the responsibility of all staff within the hospital. Important clinical aspects of care may vary from one department to another, based on the patient population and services provided. The aspects to be measured-the quality indicators-can be considered from four points of view: (1) high volume activities, (2) high risk activities, (3) problem prone activities, and (4) high cost activities.1 Postoperative pain management in a surgical department seems to meet these criteria.Several authors have reported that the treatment of postoperative pain is inadequate for many patients, some of whom still suffer moderate to severe pain. [2][3][4] Klopfenstein et al 5 considered the reasons for poor postoperative pain management as insufficient education and training fo...

Pain Levels of Orthopedic Surgery Patients and Pain Perceptions of Their Relatives and Nurses

“…[9,27] Most of the studies comparing nurses' pain assessments with patients' pain ratings confirm that there is underestimation. [8,11,[16][17][18][19][20][21][22][23][24][25] In the present study; it was found that the pain scores given by nurses were significantly lower than patients' pain scores. In addition; the second main purpose of this study was investigating the pain perception of the relatives in the hospital and was found no signifi- …”

“…[12] Previous studies show that nurses have tendency to underestimate their patients' pain. [8,11,[16][17][18][19][20][21][22][23][24][25] Underestimation of pain may result with inadequate nursing care and treatment, certain physical and psychological problems and also brings greater annual economic costs. [6,19,26,27] There are many reasons behind the underestimation of pain by nurses.…”

“…Data Collecting Form is prepared by the researchers in accordance with the literature [8,11,[16][17][18][19][20][21][22][23][24][25] and includes questions related to demographic characteristics, past hospital experiences, pain beliefs and attitudes.…”

Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

“…Reoperation and readmission rates were the next most frequently reported QIs [9,10,16] along with patientcentered QIs [2,17,21]. The Chambers and Clarke and Haynes et al articles were neither pediatric nor orthopaedic-specific so it is difficult to delineate what the reoperation or readmission rates would be for these specific populations.…”

“…The vast network of Shriners Hospitals for Children treats orthopaedic problems and burns and began a systemwide outcome management effort to validate their quality of care using a patient and family perception of care inpatient survey [21]. No pediatric subjects were included in the Idvall report [17].…”