Implementation of the quality management system improves postoperative pain treatment: a prospectivepre-/post-interventional questionnaire study

Abstract

BackgroundAn organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients’ requirements.MethodsPatients from the orthopaedic, gynaecological, visceral, and trauma surgery departments of the university hospital were involved in two prospective surveys. Survey 1 was performed at baseline and survey 2 was performed after the implementation of QMS within an interval of 1 year. The patients were asked to report pain intensity on the visual rating scale, incidence of analgesia-related side-effects, and incidence of pain interference with the items of life quality and their satisfaction with the treatment of POP.ResultsPatients from Survey 2 (n=251) reported 25–30% less pain than those from Survey 1 (n=269) (P<0.0001). Nausea was reported by 40% of the patients from Survey 1 vs 17% from Survey 2, vomiting by 25 vs 11% and fatigue by 76% in Survey 1 vs 30% in Survey 2 (P<0.0001). Life quality and patients’ satisfaction improved in Survey 2 vs Survey 1 (P<0.001).ConclusionsThe implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction.

Factores asociados con la intensidad del dolor en pacientes mexicanos hospitalizados en periodo postoperatorio

“…(17) y Usichenko y cols. (18). Referente a la persona que proporciona la orientación, es relevante señalar que sólo una mínima proporción reportó haber recibido la orientación por enfermería.…”

“…Sin embargo, existen factores, como el deficiente conocimiento y experiencia del personal de salud (9,16,17), la mala actitud del personal hacia el dolor (5,18) o las barreras ambientales de tipo organizacional (déficit de recursos, insuficiente cantidad de personal y, por consiguiente, sobrecarga de pacientes asignados), que son relacionados con un manejo inadecuado (2,4,12,17,19,20). Otros factores se atribuyen a la indicación del tratamiento analgésico en forma intermitente y no con horarios (10,20), así como al temor por parte del personal médico a indicar o administrar algún opioide por miedo a generar adicción y por los posibles efectos secundarios, como depresión respiratoria, náuseas y vómitos (5,16,19,21).…”

Quality changes in postoperative pain management: Comparison of two periods

“…Sekiz Avrupa ülkesi ve İsrail'de yürütülen bir çalışmaya göre (n=4.576) ameliyattan 24 saat sonra hastaların en şiddetli ağrı puan ortalamalarının 5,16 olduğu 17 ; Sloman ve arkadaşlarının yaptıkları çalışmada 18 cerrahi hastalarının %75'inin şiddetli ve orta düzeyde ağrı hissettikleri, ülkemizde ise Özer ve arkadaşlarının 19 yaptıkları çalışmada hastaların %93,7'sinin şiddetli, %50,2'sinin yanma/sızı şeklinde ağrı yaşadıkları belirlenmiştir. Literatürde ağrının etkin bir şekilde kontrol edilmesine yönelik uygulanan kalite yönetimi sonuçlarına göre hastaların ameliyat sonrası yaşadığı en şiddetli ağrı puanında anlamlı olarak azalma olduğu gösterilmiştir 11 .…”

Can perioperative haemodynamics and opioid requirement in Abdominal Hysterectomy be influenced by a premedication drug?

“…1 The most common reasons of prolonged recovery are drowsiness, sedation, vomiting, nausea and pain. 2 Opioids are used during perioperative period in several patients.…”