Date of Award

3-2023

Document Type

DNP Project

College

School of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Carol Rossman

Second Advisor

Timothy Chavis

Abstract

Background

Postoperative pain is contributing to the nation's opioid epidemic. Pain is an unpleasant sensation felt by the patient. When it is experienced postoperatively, it is a result of the surgical process. Patients up to 80% worldwide state that their pain is not controlled to their satisfaction. When postoperative pain is not treated adequately, it can contribute to chronic pain.

Purpose

Perioperative pain assessment and treatment policy at a rural critical access hospital and compare it to evidence-based guidelines for best practice. The project assessed the patient's pain treatment effectiveness compared to the pain management policy by using the CDC framework for program evaluation (CDC, 2017). Then, the policy was evaluated for compliance with the latest evidence-based recommendations for perioperative pain management and to give recommendations to revise the current policy.

Method

To evaluate the perioperative pain management policy, surgery patients at a rural critical access hospital surgery department were given an adapted version of the Revised American Pain Society Patient Outcome Questionnaire. Patients were asked to participate in the questionnaire in the preoperative setting, where they would sign consent. They were then given the questionnaire in an envelope to fill out and return via mail. Patients' charts were also reviewed to look at pain management treatments such as medications and to assess if they had received pain management education. A total of 56 questionnaires were given out. However, only 30 of those were returned. The data collected from the questionnaires and chart review was then analyzed.

Results

Overall, patients were satisfied with their care, with a mean rating of 8.97 out of 10. When patients were asked how much pain control had been achieved 24 hours after surgery, 76.7 % of the participants indicated they had 70% or more pain relief. The average pain ratings 24 hours before surgery were 3.9/10 for the least pain and 5.9/10 for the worst pain after surgery. Postoperatively the average pain ratings 24 hours after surgery were 3.3/10 for the least pain and 5.9/ 10 for the worst pain. The chart review indicated a lack of documentation, assessment, and education. Based on the questionnaire and the chart review results, recommendations about improved documentation, assessment, patient education, and nursing education were given to the facility. Also, the recommendation was given to have the perioperative pain management policy align with recommendations by the American Society for Anesthesiologists and the American Society for Peri Anesthesia Nurses.

Conclusion

Postoperative pain management is essential to a patient's well-being. Their pain must be controlled to their satisfaction. The facility does appear to provide pain control for patients. However, when their current policy about perioperative pain management was compared to the questionnaire, chart review, and evidence-based practice, recommendations for improvement could be made. These were given to the facility. The current plan incorporates the recommendations to improve their policy and care.

Subject Area

Postoperative pain; Operating room nursing; Nursing; Surgical nursing

DOI

https://dx.doi.org/10.32597/dnp/17/

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