Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a <scp>PAIN OUT</scp> project

Cui, Cui; Wang, Lingxiao; Li, Qi; Zaslansky, Ruth; Li, Li

doi:10.1111/jocn.14224

Cited by 23 publications

(22 citation statements)

References 20 publications

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“…These studies reported significantly increased use of morphine by 12.7% ( P < .05) and tramadol by 12.0% ( P < .05), as well as reduced pain intensity; however, no changes in opioid‐related ADEs or LOS were shown. In contrast, 4 studies used pain scales to assess pain severity and provide treatment using multimodal strategies including nonpharmacological and nonopioid methods . The use of opioid analgesics varied in these studies, however, significantly increased use of nonpharmacological pain management (60.0 vs 96.0%; P < 0.05) and nonopioid analgesia (38.8 vs 66.2%; P < 0.05) were reported .…”

Section: Resultsmentioning

confidence: 90%

“…Fifteen interventions involved surgical inpatients, 3 were implemented in the intensive care unit, 7 were conducted in the ED, 5 involved geriatric inpatients (≥65 years), and the remaining 7 studies were conducted in all inpatients, and those receiving patient‐controlled analgesia (PCA) or transdermal fentanyl …”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias assessment was performed for 4 RCTs and 33 nonrandomised studies (). Out of the 31 articles in which opioid use was evaluated as a primary outcome, 24 studies were graded as having either a moderate or serious risk of bias, largely due to confounding or selection of participants into the study . A moderate or serious risk of bias was found in 3 of 6 studies in which opioid use was addressed as a secondary outcome .…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐one studies examined the effect of interventions to improve prescribing or clinical outcomes related to opioid use. Interventions used to improve appropriate opioid use for analgesia included 16 articles which employed a multifaceted intervention to educate health providers (such as prescribers, nurses, pharmacists) and patients to change opioid use, 5 studies using decision‐making tools to guide opioid prescribing and 10 that targeted pain monitoring and response to analgesic treatment . Predominant prescribing outcomes included the quantity of opioids prescribed and compliance to published guidelines, while clinical outcomes included pain intensity, opioid‐related ADEs and patient satisfaction with adequate pain control.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, 4 studies used pain scales to assess pain severity and provide treatment using multimodal strategies including nonpharmacological and nonopioid methods . The use of opioid analgesics varied in these studies, however, significantly increased use of nonpharmacological pain management (60.0 vs 96.0%; P < 0.05) and nonopioid analgesia (38.8 vs 66.2%; P < 0.05) were reported . These changes were associated with improved clinical outcomes including reduced pain intensity ranging from 27.2 to 38.5%, reduced duration of mechanical ventilation (median 46 vs 79 h; P < .06), and a nonsignificant reduction in LOS …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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Aims To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. Methods Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). Results Of 398 full‐text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty‐one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard‐copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient‐controlled analgesia reduced medication errors by up to 89.1%. Conclusion Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Lovecchio

Premkumar

Stepan

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Current research on opioid use within orthopedic surgery has focused on efforts to identify patients at risk for chronic opioid use. Studies addressing prevention of opioid misuse related to orthopedic care are lacking. Evidence-based interventions to reduce the reliance on opioids for post-operative pain relief will be a key component of any comprehensive institutional opioid policy. Questions/Purposes: The purpose of this systematic review was to evaluate institutional strategies that reduce opioid administration or consumption after orthopedic surgery. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for English-language articles that analyzed interventions by physicians, nurses, pharmacists, physical therapists, or other hospital staff to reduce postoperative opioid use or narcotic prescription amounts after surgery. Studies that contained objective outcome measures (i.e., no expert opinion articles) were selected. Investigations on the effect of pharmacologic adjuvants, cryotherapy, or regional nerve blockades on opioid use were excluded. Results: The initial search yielded 6598 titles, of which 13 full-text articles were ultimately selected for inclusion in this systematic review. The review identified two major categories of interventions-patientfocused and provider-focused (e.g., physicians, nurses, physical therapists, pharmacists). Formal patient education programs were most effective in reducing opioid use. On the provider side, prescribing guidelines appear to decrease the overall number of pills prescribed, often without changes in patient satisfaction or requests for refills. Conclusions: Researchers are just beginning to establish the most effective ways for institutions to reduce opioid use and promote responsible post-operative prescribing. Institutional prescribing guidelines, standardized bedside pain-management programs, and formal patient education curriculums are all evidence-based interventions that can achieve these goals. The available research also supports an interprofessional approach in any institutional opioid-reduction strategy.

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Implementation and evaluation of a pain management core competency education program for surgical nurses

Ling-xiao

Herr

et al. 2021

International Journal of Nursing Sciences

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Objective To investigate the effect of a pain management core competency education program on surgical nurses’ pain knowledge and pain management nursing practice behaviors. Methods An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain, pain assessment, pharmacological and non-pharmacological management, and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team. Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used. The Clinical Pain Knowledge Test (CPKT) was completed by 135 and 107 nurses from 17 surgical wards pre and post-program, respectively. Two hundred and three patients’ medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention, respectively. Documentation of patients’ postoperative pain management nursing practice behaviors and pain intensity scores were collected. Results After the intervention, the CPKT scores of nurses significantly increased from 45.6% ± 12.3% to 54.2% ± 10.2% ( t = 5.786, P < 0.001). Nurses’ postoperative pain management nursing practice improved, with proportion of pain assessment documentation increased from 59.6% (121/203) to 74.9% (152/203) ( χ 2 = 10.746, P = 0.001), those using pain intensity assessment tools increased from 81.8% (99/121) to 95.4% (145/152) ( χ 2 = 13.079, P < 0.001), and intramuscular injection of nonopioids decreased from 12.6% (13/103) to 2.7% (3/111) ( χ 2 = 7.598, P = 0.006). Patients’ average worst pain score on the operation day significantly decreased ( Z = −2.486, P = 0.013), and scores from the first to the third postoperative day also decreased ( Z = −2.172, P = 0.030). Conclusions Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management, improve selected pain management practices, and decrease patients’ postoperative pain intensity.

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Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project

Cited by 23 publications

References 20 publications

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Implementation and evaluation of a pain management core competency education program for surgical nurses

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