Pain Management and Its Possible Implementation Research in North Ethiopia: A before and after Study

Abstract

Background. Though there is an effective intervention, pain after surgical intervention is undermanaged worldwide. A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. The aim of this research project is to develop a scalable model for managing pain after cesarean section by implementing the World Health Organization’s (WHO) pain management guidelines through a combination of implementation research and quality improvement methods. Methods. We implemented the World Health Organization (WHO) pain management guidelines using effective implementation strategies. First, we conducted a formative qualitative exploration to identify enablers and obstacles. In addition, we took base-line assessment on pain management implementation process and outcome using a checklist prepared from the guideline and an adapted American Pain Outcome assessment tool version 2010, respectively. Then, we integrated the guidelines into the existing practice by using collaborative iterative learning strategy. We analyzed the data by Statistical Packages for Social Sciences (SPSS) version 21. We compared the before and after data using chi-squared and Fischer’s exact test. A change in any measurement was considered as significant at p value 0.05. Result. We collected data from 106 mothers before and 110 mothers after intervention implementation. We successfully integrated pain as a fifth vital sign in more than 87% (p value <0.001) of patient, and fidelity was approximately 59% (p value <0.001). In addition, we significantly improved pain outcome measures after the implementation of the intervention. Conclusion and Recommendations. A systematic approach to implement pain management guidelines was successful. We recommend the ward sustain these gains and that hospital, the region, and the nation to replicate the success.

Pain assessment practice and associated factors among nurses working at adult care units in public hospitals in Wolaita Zone, Southern Ethiopia, 2021

“…The evidence shows that pain is one of the main reasons patients seek medical care [3][4][5][6]. Untreated pain has an impact on patients' clinical and psychological well-being, as well as hastens their risk of mortality and has a slew of other negative repercussions, such as raising treatment expenses, lengthening hospital stays, and lowering their quality of life [2,[7][8][9][10][11].…”

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

“…Only eight articles mentioned the use of QI methods. Five of these studies used Plan–Do–Study–Act cycles,37 38 43 44 47 one used QI collaboratives,48 and two used audit and feedback as the QI method 49 50. Use of implementation science frameworks was rare with only two studies using frameworks to support intervention implementation and the evaluation of implementation 51 52…”

“…We found that almost all the studies focused on either safety32–35 40–42 44–46 48 51–53 59–81 and/or effectiveness of care, with a lack of focus on other domains of quality. The prioritisation on safety was not surprising given the well-recognised magnitude of the patient safety problem21 and the resultant global movement to improve patient safety.…”