Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management

Abstract

Objectives This study aimed to establish a quality indicator system for postoperative pain management and test its reliability, validity, and discrimination in China. Methods We established a quality indicator system using the Delphi method. Further, we designed and administered a survey questionnaire in the orthopedic departments of nine hospitals, located in the Zhejiang and Jiangsu Provinces, through purposive and convenience sampling methods to examine the reliability, validity, and discrimination of the quality indicator system. Results We established a quality indicator system to assess structure, process, and outcome measures of postoperative pain management using three first-level, eight subordinate second-level, and 32 subordinate third-level quality indicators. The scale-level content validity indexes of the three sections of the questionnaire, assessing structure, process, and outcomes measures, were 0.99, 0.98, and 0.98, respectively. We identified two common factors from the third section that demonstrated a cumulative variance contribution rate of 80.38% and a Cronbach’s α coefficient of 0.95. The total scores and scores of the structure, process, and outcome quality indicators demonstrated statistically significant differences (P < 0.05) between the wards (N = 4) that participated in the “Painless Orthopedics Ward” quality improvement program and those (N = 5) that did not. Conclusions This quality indicator system highlights the need for multidisciplinary cooperation and process characteristics of postoperative pain management, along with interdepartmental quality comparisons. And it demonstrates acceptable reliability, validity, and discrimination; thus it may be completely or partially employed in Chinese hospitals.

Development of core pain management indicators for hospitalized patients: a Delphi study

“…Nurses selected assessment tools according to the age and speci c conditions of patients, from the Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Faces Pain Scale-Revised (FPS-R). The NRS was composed of 11 numbers with the same interval from 0 to 10: no pain (0), mild pain (1-3), moderate pain (4-6), and severe pain (7)(8)(9)(10). VDS used "no pain, mild pain, moderate pain, severe pain, severe pain, and the most pain" to represent different levels of pain intensity.…”

“…A review of relevant literature found that scholars from all over the world have mainly used different methods to construct evaluation systems to evaluate the quality of hospital nursing and pain nursing management. For example, Chen Jiajia et al constructed the quality index system of postoperative pain management in China through the Delphi method, including a total of 43 evaluation indicators from three aspects of structure, process, and result, to evaluate the quality of postoperative pain management [10]. However, there are many complicated indicators and it is not easy to promote in clinical practice.…”

Postoperative pain-related outcomes and perioperative pain management in China: a population-based study

“…14 Most of the published studies on acute postoperative pain in China mainly limited in specific region or a certain type of surgery, and the patient sample were much small. 15 , 16 , 17 In the PAIN-OUT China study, 18 , 19 , 20 we studied acute postoperative pain in 2520 patients from 12 hospitals, from which we got a preliminary understanding of acute postoperative pain in China. Considering the large number of hospitals in China and the significant variation in medical levels among regions, in this study we conducted a survey with 122 research centers to evaluate the current status of acute postoperative pain in China.…”