Patient and nurse assessment of quality of care in postoperative pain management

Differences in Perception of Healthcare Management between Patients and Professionals

Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.

Validation and Scoring of the Greek Version of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) Questionnaire

PURPOSE

The aim of this study was to validate the Greek version of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire.

DESIGN

The study was designed as a prospective questionnaire survey.

METHODS

Overall, 210 elective surgical patients were included . SCQIPP consisted of 14 items that were scored on a five point scale. After the translation and linguistic adjustments, the tool was distributed to the surgical wards. Internal consistency reliability was assessed by Cronbach's alpha. The tool construct was generated by a principal axis factoring model with promax rotation.

FINDINGS

Base Cronbach's alpha was 0.814. Due to low inter-item and item-total correlations and the increase of Cronbach's alpha (0.834) when item two was deleted, 13 items were included in the current tool version. Factor analysis identified three district subscales: nursing care, pain management, and support. Subscale and convergent validity were confirmed. The mean score of the validated tool was 55.2 (Range: 44-63). A low level of care was highlighted in most items.

CONCLUSIONS

The Greek version of the SCQIPP questionnaire is a valid and efficient tool for the evaluation of the quality of care of postoperative pain management.

Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery

BACKGROUND

Persistent postsurgical pain (PPSP) is a common complication that impacts quality of life, often necessitating long-term opioid treatment. Certain neurocognitive factors, including reduced performance on cognitive flexibility tasks, are associated with increased risk of PPSP. We examine the perceptions of surgical patients and clinicians with regard to perioperative pain management activities and needs; patient acceptance and use of a perioperative neurocognitive training intervention; and implementation feasibility.

METHODS

We conducted both individual and focus group interviews with patients undergoing thoracic surgery and clinicians in an academic medical center. The Consolidated Framework for Intervention Research guided the development of interview questions related to the adoption and implementation of a neurocognitive intervention to mitigate PPSP. A thematic analysis was used to analyze the responses.

RESULTS

Forty patients and 15 clinicians participated. Interviews revealed that there is minimal discussion between clinicians and patients about PPSP. Most participants were receptive to a neurocognitive intervention to prevent PPSP, if evidence demonstrating its effectiveness were available. Potential barriers to neurocognitive training program adoption included fatigue, cognitive overload, lack of familiarity with the technology used for delivering the intervention, and immediate postoperative pain and stress. Implementation facilitators would include patient education about the intervention, incentives for its use, and daily reminders.

CONCLUSION

The study identified several guiding principles for addressing patients' and clinicians' barriers to effectively implementing a neurocognitive training intervention to mitigate PPSP after surgery. To ensure the sustainability of neurocognitive interventions for preventing PPSP, such interventions would need to be adapted to meet patients' and clinicians' needs within the perioperative context.

Remote transmission monitoring for postoperative perineural analgesia after major orthopedic surgery: A multicenter, randomized, parallel-group, controlled trial

STUDY OBJECTIVE

After surgery, patients reported the delay in receiving help as the primary factor for poorly controlled pain. This study aimed to compare the effectiveness of patient management through two communication modalities: remote transmission (RT) versus bedside control (BC). We hypothesized that using remote technology for pump programming may provide the best postoperative infusion regimen for the patient's self-assessment of pain and adverse events.

DESIGN

A multicenter, randomized, parallel-group, controlled trial.

SETTING

Anesthesiology department and orthopedic surgery ward at three university hospitals.

PATIENTS

Eighty patients undergoing orthopedic surgery with postoperative perineural patient-controlled analgesia were included.

INTERVENTIONS

Two groups (n = 40 for each group) were formed by randomization. In the postoperative period, perineural analgesia was followed up via an RT system or BC for 72 h.

MEASUREMENTS

A nurse assessed daily pain, sensory and motor blocks and adverse events. Patients completed a questionnaire three times a day and alerted for any problem according to the group (RT system or nurses' follow-up). On the third postoperative day, the nurse removed the catheter, completed the final assessment, and collected the historical data from the pump. A physician's shorter response time to change the patient control analgesia (PCA) program was the primary endpoint.

RESULTS

Of the 80 patients, 71 were analyzed (34 were randomized to the RT group and 37 to the BC group). Fifty-eight pump setting changes were noted. Analysis of repeated evaluations shows that mean time (SD) to change the PCA pump settings was significantly lower in the RT group (20 min (22.3 min)) than in the BC group (55.9 min (71.1 min)); mean difference [95% CI], -35.9 min [-74.3 to 2.4]); β estimation [95% CI], -34 [-63 to -6], p = 0.011). Pain relief, sensory and motor blocks did not differ between the groups: β estimation [95% CI], 0.1 [-0.4 to 0.6], p = 0.753; 0.5 [-0.4 to 1.4], p = 0.255; 0.9 [-0.04 to 1.8], p = 0.687, respectively. β = -34 [-63 to -6], p = 0.011). The consumption of ropivacaine, nurse workload and the cost of the analgesia regimen decreased in the RT group. No differences were noted in satisfaction scores or complication rates.

CONCLUSIONS

The response time for the physician to change the PCA program when necessary was shorter for patients using RT and alerts to the physician were more frequent compared with spot checks by nurses. RT helps to decrease nurses' workload, ropivacaine consumption, and costs but did not affect postoperative pain relief, complication rate, or patient-reported satisfaction score.

IRB CONTACT INFORMATION

Comité de Protection des Personnes, Sud Méditerranée III, Montpellier-Nîmes, France, registration number EudraCT A01698-35.

CLINICAL TRIAL NUMBER

ClinicalTrials.gov ID:NCT02018068 PROTOCOL: The full trial protocol can be accessed at Department of Anesthesiology and Critical Care Medicine, Medical Research and Statistics Unit, Lapeyronie University Hospital, Avenue Doten G Giraud, Montpellier, France. s-bringuierbranchereau@chu-montpellier.fr.

Relationship Between Quality of Care and Patient Care Outcomes for Postoperative Pain in Major Orthopedic Surgery: Analytical and Cross-Sectional Study

The quality of care provided for the management of postoperative pain and patient outcomes are key criteria for healthcare institutions. This study aimed to determine the relationship between the quality of care provided for the alleviation of postoperative pain experienced among patients undergoing major orthopedic surgery and the patient care outcomes. The study was designed as an analytical and cross-sectional study. The rates of pain severity and sleep interference, activity interference, affective experiences, and adverse effects due to postoperative pain were higher in female patients than in male patients. A significant positive correlation was identified between the quality of postoperative pain care and the perception of care (p < .05). Implementing nursing interventions to improve pain management and increase the quality of care appears to be vital elements for reducing adverse effects caused by pain and increasing the satisfaction with postoperative pain care.

Assessment of the Quality of Nursing Care of Postoperative Pain in Patients Undergoing Vascular Procedures

PURPOSE

The purpose of this study was to evaluate the quality of nursing care of postoperative pain management in patients who underwent vascular procedures.

DESIGN

A survey using patient questionnaires.

METHODS

The sample was composed of 100 patients, aged 52 to 86 years, admitted to the Clinic of Cardiac and Vascular Surgery, University Clinical Centre, Gdansk, Poland. The study included the use of an interview questionnaire, that is,.e. a standardized research tool-the Strategic and Clinical Quality Indicators in Postoperative Pain Management scale and a questionnaire designed to record sociodemographic characteristics.

FINDINGS

Analysis of the data indicated that the most numerous group of patients were men (80%). The total mean score obtained with the Strategic and Clinical Quality Indicators in Postoperative Pain Management scale was 59.2 points (range, 14 to 70) meaning that the high quality of nursing care in each area was not provided. The results of this research revealed areas for improvement in postoperative pain management on the subscales: communication (12.9 points), action (15.3 points), and environment (12.5 points).

CONCLUSIONS

The overall level of quality of nursing care in terms of postoperative pain management as reported by patients after vascular procedures was not fully satisfying, and nursing care should improve. This indicates the need to educate nurses in postoperative pain management, its monitoring and prophylaxis, and communication techniques with patients. Our study indicates that gender, place of residence, education level, and satisfaction with pain management influence the assessment of the quality of care.

Management of acute pain in the postoperative setting: the importance of quality indicators

Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care provided to patients. QIs can be used to assess various aspects relating to the care process and they have proven useful in improving health outcomes in diseases such as myocardial infarction. In this commentary we critically analyze the evidence regarding the use of QIs in acute POPM based upon the experience of pain specialists from Europe and the USA who are members of the Change Pain Advisory Board. We also undertook a literature review to see what has been published on QIs in acute pain with the goal of assessing which QIs have been developed and used, and which ones have been successful/unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly trained, multidisciplinary team and it is at this level that major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving clinical outcomes. Changes in structure and processes to deliver high-level quality care need to be regularly audited to ensure translation into better outcomes. QIs can help drive this process by providing an indicator of current levels of performance. In addition, outcomes QIs can be used to benchmark levels of performance between different healthcare providers.

Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery

BACKGROUND

After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief, and their use may exacerbate the incidence of sedation, nausea, and vomiting, which ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia after surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium rectal suppositories may be used to relieve pain and minimize side effects; however, their efficacy has not been confirmed.

OBJECTIVE

We aimed to evaluate the use of belladonna and opium suppositories for pain reduction in vaginal surgery.

MATERIALS AND METHODS

A prospective, randomized, double-blind, placebo-controlled trial that used belladonna and opium suppositories after inpatient or outpatient vaginal surgery was conducted. Vaginal surgery was defined as (1) vaginal hysterectomy with uterosacral ligament suspension or (2) posthysterectomy prolapse repair that included uterosacral ligament suspension and/or colporrhaphy. Belladonna and opium 16A (16.2/60 mg) or placebo suppositories were administered rectally immediately after surgery and every 8 hours for a total of 3 doses. Patient-reported pain data were collected with the use of a visual analog scale (at 2, 4, 12, and 20 hours postoperatively. Opiate use was measured and converted into parenteral morphine equivalents. The primary outcome was pain, and secondary outcomes included pain medication, antiemetic medication, and a quality of recovery questionnaire. Adverse effects were surveyed at 24 hours and 7 days. Concomitant procedures for urinary incontinence or pelvic organ prolapse did not preclude enrollment.

RESULTS

Ninety women were randomly assigned consecutively at a single institution under the care of a fellowship-trained surgeon group. Demographics did not differ among the groups with mean age of 55 years, procedure time of 97 minutes, and prolapse at 51%. Postoperative pain scores were equivalent among both groups at each time interval. The belladonna and opium group used a mean of 57 mg morphine compared with 66 mg for placebo (P=.43) in 24 hours. Patient satisfaction with recovery was similar (P=.59). Antiemetic and ketorolac use were comparable among groups. Subgroup analyses of patients with prolapse and patients <50 years old did not reveal differences in pain scores. The use of belladonna and opium suppositories was uncomplicated, and adverse effects, which included constipation and urinary retention, were similar among groups.

CONCLUSION

Belladonna and opium suppositories are safe for use after vaginal surgery. Belladonna and opium suppositories did not reveal lower pain or substantially lower narcotic use. Further investigation may be warranted to identify a population that may benefit optimally from belladonna and opium use.

Patient Perception of Acute Pain Management: Data from Three Tertiary Care Hospitals

Introduction. The primary objectives of this study were to assess patients' description of their acute pain intensity; patients' attitude towards their pain management during hospitalization; and their overall satisfaction with pain treatment. Methodology. A cross-sectional questionnaire-based study was conducted between October 2014 and March 2015 in three medical centers in Lebanon. All participants' responses were reported using descriptive statistics. The association between categorical variables was evaluated using Pearson χ² test or Fisher's exact test where the expected cell count was < 5. Results. A total of 119 women on the maternity services and 177 patients on the orthopedic services were surveyed. Around 50% of obstetric and 37% of orthopedic patients reported pain to be severe at its highest intensity. In maternity and orthopedic patients, respectively, unfavorable practices included pain not being assessed prior to pain medication administration (19.3% and 30.5%), having to wait for ≥30 minutes before getting the pain medication (14.2% and 11.3%), and pain score not being documented on medical chart (95% and 93.2%). Surprisingly, 94.1% of the maternity and 89.2% of orthopedic patients were satisfied to strongly satisfied with their pain management. Conclusion. Pre- and postoperative pain remain a prevalent problem that requires a consensus and joint efforts for improvement.

Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective

RATIONALE, AIMS AND OBJECTIVES

Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery.

METHODS

A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge.

RESULTS

In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted.

CONCLUSIONS

There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.

Fast-track recovery after major liver and pancreatic resection from the nursing point of view

Postoperative fast-track recovery protocols combine various methods to support immediate care of patients who undergo major surgery. These protocols include control of postoperative pain and early beginning of oral diet and mobilization. The combination of these approaches may reduce the rate of postoperative complications and facilitate hospital discharge. The aim of this study was to evaluate progress and parameters of fast-track recovery after major liver and pancreatic resection. A descriptive bibliographical review from 2001 to 2012 via electronic databases such as MEDLINE, PubMed, and Google Scholar was undertaken. Articles that focused on a fast-track protocol were studied. Reports focusing on the implementation of a fast-track protocol in the postoperative recovery of patients after major hepatectomy or pancreatectomy were selected. Fast-track protocols may be applicable to patients recovering after major liver or pancreatic resection. Future research should be focused on particular parameters of the fast-track protocol separately.

A Study of Patients and Nurses' Perception of the Quality of Pain Management in the Patients Undergoing Surgery in the Departments of Surgery of Rasht Hospitals in 2013

PURPOSE & FIELD

More than one hundred million people around the world undergo a surgery annually. Although, the surgery itself is a treatment method to relieve pain and discomfort, it can be considered as one of the important factors to make a pain too. Perception and diagnosis of the pain is the most important duty of nurses. Effective pain management after surgery facilitates the patient's recovery, decreases the length of hospitalization and increases the patient satisfaction. This study aims to investigate the patients and nurses' perception of the quality of pain management in the patients undergoing an abdominal surgery.

MATERIALS & METHODS

The current study is a descriptive research that has been conducted on 204 candidate patients for the abdominal surgery and the nurses who care them in the departments of surgery of Rasht hospitals by using the Simple Random Sampling method. The necessary tools in gathering data for the questionnaire consist of demographic characteristics. Idval,E et al's Questionnaire for evaluation and pain perception, numerical and visual evaluation tools for the patient and nurse satisfaction with pain relief. Statistical analysis has been made through the 16 version of SPSS software by using descriptive statistics, average and standard deviation.

FINDINGS

The results show that the level of patient satisfaction with providing necessary care to relieve pain was 29.1% (maximum), 20.8% (minimum) and 78.7% to the confidence, environment and all areas, respectively. For the nurses, this level was 32.4% (maximum), 16.4% (minimum) and 77.1% to the performance, environment and all areas, respectively. The maximum level of patient perception of satisfaction with pain relief was 49.1% and for the nurses, it was 37.7% (good level).

CONCLUSIONS

The results indicated that the patients' perception of providing necessary cares to relieve pain and their satisfaction with the pain relief are more than the nurses and in a good level.

Patients' Perceptions of Quality of Care During the Perioperative Procedure

PURPOSE

To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement.

DESIGN

A cross-sectional descriptive survey design was used.

METHODS

The data were collected (N = 170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text.

FINDING

The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalized information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety.

CONCLUSIONS

This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context.

Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management

Pain is a common complaint among hospitalized patients no matter the diagnosis. Pain has a negative effect on many aspects of a patient's life, including quality of life, sleep, and activities of daily living as well as increased health care expenses. The aim of this study was to evaluate the effectiveness of an intervention (script-based communication, use of white boards, and hourly rounding) related to pain management on patient satisfaction with nurses' management of pain. A prospective, quasi-experimental pretest-posttest design was used. Data were collected from two units that provided care for patients with a variety of medical-surgical diagnoses in a hospital located in an academic health sciences center in the southern United States. When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.

Validation study of the strategic and clinical quality indicators in postoperative pain management questionnaire in Turkish surgery patients

Determining patient satisfaction with postoperative pain management is an important intervention to improve strategies for effective pain control. The aim of this study was to validate an English version of the 14-item Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire in Turkish language. The study included 113 patients who underwent elective surgeries at a university hospital in Bursa, Turkey. The data were collected after translation procedures and final adjustments were done on the original instrument. For the total scale, Cronbach's coefficient α was 0.81 and the main score obtained from the scale was 45.8 ± 10.8. Included were three subscales: nursing interventions, pain management, and environments. Of the patients, 40.7% reported more pain than expected in the postoperative period and their satisfaction with pain relief was 7.4 ± 2.5. This instrument is a reliable and valid instrument in Turkish language and can be used to evaluate the effectiveness of postoperative pain management.

Pain: a quality of care issue during patients' admission to hospital

AIM

To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge.

BACKGROUND

The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals.

DESIGN

A descriptive cross-sectional exploratory design.

METHOD

A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge.

FINDINGS

A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs.

CONCLUSION

Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience.

Hospital patients' reports of medical errors and undesirable events in their health care

OBJECTIVE

To investigate hospital patients' reports of undesirable events in their health care.

DESIGN

Cross-sectional mixed methods design.

PARTICIPANTS

A total of 80 medical and surgical patients (mean age 58, 56 male).

INTERVENTION

Patients were interviewed post-discharge using a survey to assess patient reports of errors or problems in their care. Patients' medical records and notes were also reviewed.

MAIN OUTCOME MEASURES

Frequency of health care process problems, medical complications and interpersonal problems, and patient willingness to report an undesirable event in their care.

RESULTS

In total, 258 undesirable events were reported (rate of 3.2 per person), including 136 interpersonal problems, 90 medical complications and 32 health care process problems. Patients identified a number of events that were reported in the medical records (30 out of 36). In addition, patients reported events that were not recorded in the medical records. Patients were more willing (P < 0.05) to report undesirable events to a researcher (as in the present case) than to a local or national reporting system.

CONCLUSION

Patients appear able to report undesirable events that occur in their health care management over and above those that are recorded in their medical records. However, patients appear more willing to report these incidents for the purpose of a study rather than to an established incident reporting system. Interventions aimed at educating and encouraging patients about incident reporting systems need to be developed in order to enhance this important contribution patients could make to improving patient safety.

Quality indicators in pediatric orthopaedic surgery: a systematic review

BACKGROUND

The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.

QUESTIONS/PURPOSES

We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care.

SEARCH STRATEGY

Using five standard search engines we searched the literature using terms such as "quality indicators," "orthopaedic surgery," and "pediatric." Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients.

RESULTS

The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency.

CONCLUSION

Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.

[Descriptive study of the postoperative pain assessment and documentation process in a university hospital]

Several studies have shown that patients often receive inadequate treatment of postoperative pain. The aim of the present descriptive study was to examine and analyze various data related to the postoperative pain assessment of 40 patients who underwent elective surgery. Pain journals were to be completed by patients during every waking hour for the first three postoperative days to assess both pain intensity and pain unpleasantness. A post hoc analysis of patient records permitted verification of pain assessment by nurses for each patient. The results showed that not only was postoperative pain rarely assessed using a valid scale, it was also poorly documented. In addition, when nurses assessed and documented postoperative pain using a numerical scale, their results were very different from patients' assessments. For the first postoperative day, the mean (± SD) pain intensity documented by nurses on a 0 to 10 numerical scale was 1.57±0.23, while the mean pain intensity noted by patients using the same scale was 3.82±0.41. Statistical analysis showed that there was no significant correlation between mean pain intensity documented by nurses and the mean pain intensity noted by patients.

Patient perceptions of pain management therapy: a comparison of real-time assessment of patient education and satisfaction and registered nurse perceptions

Nurses must have an understanding of their patients' perception to assist in meeting analgesic goals. Adequate patient teaching is essential. The value of a simplified tool to assess patients' satisfaction has not been widely examined. This study examined if nurses' perceptions of their patients' satisfaction with pain management are congruent with patients' self-report, and if patients' level of satisfaction corresponds with the type of therapy used and adequacy of teaching related to their pain management plan. Data were collected though a survey in a community hospital. It was designed as an evaluative study of the variables in two nursing units and as a pilot study of the survey tool. Ratings of patient satisfaction by nurses (3.8 ± 0.88 [mean ± SD]) were similar to patients' self-ratings (4.08 ± 1.06). Higher self-report of pain (visual analog scale 4.00 ± 2.22) was associated with lower levels of satisfaction (3.80 ± 0.881). Patients reporting adequate teaching rated a higher satisfaction score (4.46) than patients reporting inadequate teaching [3.59; t (48) = -3.12; p = .003]. Patients receiving intravenous analgesia as needed had higher pain VAS scores (4.74) than patients receiving other analgesia protocols [3.37; t(48) = -2.26; p = .028]. Measuring patient satisfaction has become critical in evaluating adequacy of treatment. Factors that affect patients' satisfaction with pain management include the adequacy of teaching they receive and the type of therapy they are provided. A simple survey can be a useful tool in measuring satisfaction.

[Interest of evaluation of professional practice for the improvement of the management of postoperative pain with patient controlled analgesia (PCA)]

OBJECTIVES

To evaluate the daily practice of postoperative PCA in Nancy University Hospital, in continuity with a quality program of postoperative pain (POP) care conducted in 2003.

TYPE OF STUDY

A retrospective audit of patient medical records.

MATERIAL AND METHODS

A review of all the medical records of consecutive surgical patients managed by PCA over a 5-week period in six surgical services. Criteria studied: Evaluation of hospital means (eight criteria) and of medical and nursing staff practice (16 criteria). A second audit was conducted 6 months after the implementation of quality improvement measures.

RESULTS

Assessment of the hospital means: temperature chart including pain scores and PCA drug consumption, patient information leaflet, PCA protocol, postoperative pre-filled prescription form (PFPF) for post-anaesthesia care including PCA, and optional training of nurses in postoperative pain management. EVALUATION OF PRACTICES: One hundred and fifty-nine files of a total of 176 patients were analyzed (88%). Improvements noted after 6 months: trace of POP evaluation progressed from 73 to 87%, advance prescription of PCA adjustment increased from 56 to 68% and of the treatment of adverse effects from 54 to 68%, trace of PCA adaptation by attending nurse from 15 to 43%, trace of the administration of the treatment of adverse effects by attending nurse from 24% to 64%, as did the use of PFPF from 59 to 70%.

CONCLUSIONS

The usefulness of a pre-filled prescription form for post-anaesthesia care including PCA prescription is demonstrated. Quality improvement measures include: poster information and pocket guides on PCA for nurses, training of 3 nurses per service to act as "PCA advisers" who will in turn train their ward colleagues in PCA management and the use of equipment until an acute pain team is established.

Development and evaluation of the nurse quality of communication with patient questionnaire

INTRODUCTION

Nurse/patient relationship as a complex interrelation or as an interaction of the factor patient and factor nurse has been a subject of a number of studies during the past ten years. Nurse/patient communication is a special entity, usually observed within a framework of the wider nurse/patient relationship. In that regard, we wanted to develop a standardized questionnaire that could reliably measure the quality of communication between nurse and patient, and be used by nurses.

OBJECTIVES

The main goal of this study was to develop and evaluate construct validity of the Nurse Quality of Communication with Patient Questionnaire (NQCPQ), as well as to evaluate its reliability. The goal was also to establish a measure of inter-raters reliability, using two repeated measurements of results by items and scores of the NQCPQ, on the same observed units by two assessors.

METHODS

The starting NQCPQ that consists of 25 items, was filled in by two groups of nurses. Each nurse was questioned during morning and afternoon shifts, in order to evaluate their communication with hospitalized patients, using marks from 1 to 6. To evaluate construct validity, we used the analysis of main components, while reliability was assessed using intraclass correlation coefficient and Cronbach-alpha coefficient. To evaluate interraters reliability, we used Pearson correlation coefficient.

RESULTS

Using a group of 118 patients, we explained 86% of the unknown, regarding the investigated phenomenon (communication nurse/patient), using one component by which we separated 6 items of the questionnaire. Inter-item correlation (alpha) in this component was 0.96. Pearson correlation coefficient was highly significant, value 0.7 by item, and correlation coefficient for scores at repeated measurements was 0.84.

CONCLUSION

NQCPQ is 6-item instrument with high construct validity. It can be used to measure quality of nurse/patient communication in a simple, fast and reliable way. It could contribute to more adequate research and defining of this problem, and as such could be used in studies of interaction of psychometric, clinical, biochemical, socio-cultural, demographic and other parameters as well.

Improvements and difficulties in postoperative pain management

BACKGROUND

This review examines postoperative pain (POP) management from the perspectives of healthcare providers, patients, and institutions. It summarizes current thought about POP, including difficulties and recent improvements in the field.

METHODS

Studies were identified from PubMed, MEDLINE, and the search engine Google Scholar and by hand-searching reference lists from review articles and research papers (1998-2009). The search was limited to articles published in the English language. Given the broad review of POP, a complete review of all the potential articles was not possible. Thus, an inclusion criterion was defined, and we retrieved only those studies that included the term postoperative pain treatment, together with 1 or more of the following terms: adult patients, education, interdisciplinary teams, attitudes, physicians, and nurses. Two hundred twenty studies were retrieved, and 93 studies were sufficiently close to the topic of this review. They were organized according to the following themes: POP management as it relates to healthcare providers, patients, and institutions; changing trends in healthcare education in relation to various POP interventions; and the role of policy makers concerning improvements and challenges in the management of POP.

RESULTS

Interdisciplinary teams are needed to implement multimodal methods to treat POP in ways that will provide patients with interventions that will improve their ability to cope with the physical and psychosocial aspects of POP. This is hindered by a lack of hospital financial resources, a lack of educational programs, a lack of knowledge regarding diverse pharmacological options, and lingering negative attitudes toward certain treatments, especially opioids.

CONCLUSIONS

Successful POP management depends on providers' receiving education and information. Policy makers and organizations are called upon to actively intervene by formulating programs and promoting a feedback system, or else POP will remain a neglected issue.

Assessment of quality of care in acute postoperative pain management

BACKGROUND/AIM

Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same.

METHOD

The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (X), multiple correlation coefficient (R) were conducted amongst other univariant procedures.

RESULTS

The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers "strongly agree" ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item "In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10". Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from "communication" subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from "procedure" subscale.

CONCLUSION

The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.

The quality of postoperative pain management from the perspectives of patients, nurses and patient records

AIM

To study the quality of postoperative pain management in a university hospital.

METHOD

Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented with audit of patient records. The Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire was answered by 121 patients and 47 Registered Nurses.

RESULTS

Of 14 items in the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, four items in general surgery and five items in thoracic surgery reached the threshold for high quality of care. No significant differences were found between the assessments in the two departments, but the patients in general surgery experienced more pain than the patients in thoracic surgery. In general surgery, the patients assessed their worst pain significantly higher than the nurse did. The patients who experienced more pain than expected were less satisfied with the quality of their care and experienced higher pain intensity levels. For 25 (41.0%) patients in general surgery and four (6.7%) patients in thoracic surgery, pain intensity was documented according to hospital quality goals.

CONCLUSION

In both departments, areas for improvements could be found in all subscales of the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, i.e. communication, action, trust and environment. It is important to discuss what information the patient needs, as well as how and when it should be given. Furthermore, considering earlier pain experience and the goal of pain relief for the individual patient may facilitate an adequate assessment of the patient's pain. In future, electronic health records have the potential to support the use of clinical guidelines.

Do Organizational Factors Explain the Quality of Care?

This study investigated the perceptions of patients, nurses, physicians, and managers of the quality of care. While they all evaluated the quality of care to be good, the evaluations of patients and staff were different from each other's. Organizational factors such as values and work explained the quality of care evaluated by nursing staff and physicians compared to work and leadership by managers. No obvious relationship between quality and leadership could be found.

How do patients with colorectal cancer perceive treatment and care compared with the treating health care professionals?

BACKGROUND

Patient evaluations are widely used in quality assessment of health services. It is widely recognized that patients and professionals provide a different perspective on quality. However, the extent to which they differ and the conceptual areas in which they differ is not well understood.

OBJECTIVES

We sought to examine how well professional and patient assessments of hospital health care correspond.

METHODS

We undertook a prospective study in which information from a national clinical register was combined with questionnaires to patients, surgeons, and nurses. The study included 527 patients after surgery for colorectal cancer. The patients and their professionals assessed the same questions. For 336 patients, all questionnaires and register information were available. The response rate was 64%. The main measures were assessments of technical, interpersonal, and organizational aspects of care. Agreement was analyzed by kappa statistic, kappa, and McNemar's test.

RESULTS

Comparing assessments of technical surgical care kappa statistic demonstrated moderate-to-almost perfect agreement (0.35 <or= kappa <or= 0.95). Assessments of technical nursing care demonstrated slight agreement (0.19 <or= kappa <or= 0.26). Comparing answers to questions on interpersonal or organizational care, kappa statistic revealed only slight or no more agreement than expected by chance (-0.06 <or= kappa <or= 0.30). For several items, McNemar's test revealed a significant difference in the distribution of answers.

CONCLUSIONS

Within a Danish population undergoing treatment of colorectal cancer, there were significant differences in perceptions of care between patients and health professionals. In particular, health professionals and readers of reports on patient evaluations ought to remember that patients' perspective is just one source of information in assessment of hospital health care.

Consistency of quality assessments in long-term care by the clients, family members and named nurses

Combining assessments by the clients, their family members and named nurses of the quality of long-term care leads to a more comprehensive picture of the quality of the service. Clients should be the primary source of information, but particularly when they are not able to express their opinion, other sources of assessment are needed. This study describes and compares the consistency of quality assessments of long-term institutional care for the elderly made by the client (n = 312), his/her family member (n = 312) and the named nurse (n = 312). Data were gathered in 2002 from service houses, nursing homes and health centres. The consistency of the assessments made by the different groups of respondents was measured by frequency distributions, the weighted kappa coefficient and exact agreement. Frequency distributions differed significantly between the respondent groups in almost every item. Family members were more critical in their assessments than the other two groups. The consistency of assessments was highest with regard to the items 'contact with significant others' and 'medication'. In general the consistency of assessments, measured by weighted kappa, was rather low, but it was fair for 'clothing' (clients/family members) and 'privacy' (clients/named nurses and family members/named nurses). The occurrence of the option 'not applicable' to certain items was quite high, but varied somewhat between the three respondent groups. The results of this study support the viewpoint that comprehensive information gathering from family members and named nurses is useful, but they should not replace clients' assessments.

Patients' decision-making strategies for managing postoperative pain

Despite technological advances, many postoperative patients continue to suffer unrelieved pain. The aim of this study was to identify the strategies used by postoperative patients to bring about pain management decisions. A single-group noncomparative study design was chosen using observations as the means of examining pain activities in 2 surgical units of a metropolitan teaching hospital in Melbourne, Australia. A total of 52 nurses and 312 patients participated in the study, and 316 pain activities were observed. The most common strategy used was patients acting as a passive recipient for pain relief (60%), whereas problem solving (23%) and active negotiation (17%) were less commonly used. Patients in this study were admitted for surgical treatment of a particular condition, and their subsequent pain was specifically related to this acute event. Therefore, the lack of familiarity of the situation and the severity of pain experienced may have encouraged passivity. Patients may have also felt uncertain about how to approach the pain decision, preferring to defer to nurses. Because increased pain levels can be associated with fear, patients could have been unwilling to speak with nurses to discuss their need for pain relief.

PERSPECTIVE

This paper shows that patient decision making for postoperative pain relief largely involves the use of passive requests, compared with problem solving and active negotiation. Effective communication must be supported between health professionals and patients if shared understandings about treatment options are to become a reality.

Differences between nurse and patient assessments on postoperative pain management in two hospitals

RATIONALE

Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences.

AIM

The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of postoperative pain management in two hospitals, and (2) to discuss the nature and scope of these differences.

METHOD

The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction.

RESULT

Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22-0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to underestimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only.

CONCLUSION

Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain.

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

OBJECTIVES

To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.

DESIGN

Self-rated questionnaire survey.

SETTING

Nine wards in short stay French hospitals.

PARTICIPANTS

939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).

MAIN OUTCOME MEASURE

Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.

RESULTS

The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.

CONCLUSION

There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

OBJECTIVES

To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.

DESIGN

Self-rated questionnaire survey.

SETTING

Nine wards in short stay French hospitals.

PARTICIPANTS

939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).

MAIN OUTCOME MEASURE

Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.

RESULTS

The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.

CONCLUSION

There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.

Quality of care in postoperative pain management: what is realistic in clinical practice?

This paper presents a study describing nurses' assessment of whether it was realistic to carry out good quality of care in postoperative pain management. Further, the study compared their assessment with the quality of care actually performed in clinical practice as assessed by both patients and nurses. Three questionnaires were used; one for patients (n = 198) and two for nurses (n = 63). Nurses and patients responded to similar questions; the patients assessed the quality of care they had received, and the nurses assessed the quality of care they had delivered. The nurses also responded to questions concerning whether the different aspects of good quality of care were realistic to carry out in practice. The results show that in several important aspects of postoperative pain management, both patients and nurses assessed the quality of care to be lower than the nurses' assessment of what was actually possible to effectuate in clinical practice, e.g. pain assessment and information. This finding highlights the problem of applying evidence-based care in actual clinical practice.