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Skraastad EJ, Borchgrevink PC, Nilsen TIL, Ræder J. Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study. Acta Anaesthesiol Scand 2020; 64:301-308. [PMID: 31608431 DOI: 10.1111/aas.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postoperative pain, side-effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. METHODS The trial included 195 patients randomised to a standard care group (SC-Group) or intervention group (INT-Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side-effects, patient satisfaction and length of hospital stay (LOS). RESULTS Mean time to postoperative mobilisation was 10.1 hours for patients in the INT-Group compared to 14.2 hours in the SC-Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04-2.28). INT-Group patients received a higher dose of oral morphine equivalents; 26 mg vs 15 mg, P < .001; reported lower intensity of pain on a 0-10 scale; 2.1 vs 3.3, P < .001; and had higher patient satisfaction on a 5-point scale; 4.9 vs 4.3, P < .001. The LOS was similar between the groups; 71 hours in INT-Group vs 77 hours in SC-Group, P = .58. No serious side-effects were registered in INT-Group, whereas two were registered in SC-Group. CONCLUSIONS Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03438578.
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Affiliation(s)
- Erlend Johan Skraastad
- Clinic of Anaesthesia and Intensive care St. Olavs hospitalTrondheim University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- Unit on Complex Symptom Disorders St. Olavs hospital, Trondheim University Hospital Trondheim Norway
| | - Tom Ivar L. Nilsen
- Clinic of Anaesthesia and Intensive care St. Olavs hospitalTrondheim University Hospital Trondheim Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
| | - Johan Ræder
- Department of Anaesthesia and Intensive Care Medicine Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine, Medical Faculty University of Oslo Oslo Norway
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Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017; 15:22-29. [DOI: 10.1016/j.sjpain.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Background and aim
Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.
Methods
A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.
Results
When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.
Conclusions
This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.
Implications
Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.
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Affiliation(s)
- Viveka Andersson
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Department of Medicine , Hallands Hospital Varberg , Träslövsvägen 68, 432 37 , Varberg , Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine , Institute of Medicine, The Sahlgrenska Academy , University of Gothenburg , Box 457, 405 30 , Gothenborg , Sweden
- Spenshult Research and Development Centre , Bäckagårdsvägen 47, 302 74 , Halmstad , Sweden
| | - Ingela Henoch
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Angered Local Hospital , Halmtorget 1, 424 65 , Gothenburg , Sweden
| | - Kerstin Wickström Ene
- Department of Research, Development and Education , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Eva Otterström-Rydberg
- Department of Anesthesia and Intensive Care , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Hanna Simonsson
- Department of Surgery , Hallands Hospital , Halmstad , Lasarettsvägen, 302 33 Halmstad , Sweden
| | - Karin Ahlberg
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
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Andersson V, Otterstrom-Rydberg E, Karlsson AK. The Importance of Written and Verbal Information on Pain Treatment for Patients Undergoing Surgical Interventions. Pain Manag Nurs 2015; 16:634-41. [PMID: 25979458 DOI: 10.1016/j.pmn.2014.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 10/03/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Abstract
Patients who undergo a surgical intervention require information in the preoperative phase. Few qualitative studies are available that illuminate the importance of preoperative information for patients' experiences of postoperative pain management. The aim of this study was to examine patients' perceptions of preoperative information about pain treatment as well as its importance for the way pain was managed in the postoperative phase. A descriptive, qualitative study using individual interviews was performed. Content analysis was employed to analyze individual interviews with 18 patients who had undergone total hip or knee joint plastic surgery. Every second participant received verbal information on pain treatment in the standard way at the preoperative discussion, whereas the others were also provided with written information. The interviews took place in a public hospital, on the second or third postoperative day, between September and November 2010. The study revealed that a combination of written and verbal information on pain relief was perceived as valuable by the patients. Four main categories were identified: The form of information; the content of the information; the patients' experience of postoperative pain relief, and factors that influenced the patients' experience of pain relief. The theme "Participation" emerged from the latent content. Preoperative information on pain relief facilitated increased patient participation. Health care professionals often aim to ensure that patients participate in the care, but the latter sometimes lack the desire, strength, or ability to become involved.
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Affiliation(s)
- Viveka Andersson
- Department of Medicine, Hallands Hospital Varberg, Varberg, Sweden.
| | | | - Ann-Kristin Karlsson
- Department of Research Development and Education, Hallands Hospital Varberg, Varberg, Sweden
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Granan LP, Jacobsen HB, Reme SE, Stubhaug A, Hansson P, Breivik H, Ljoså TM. Tverrfaglig utdanning for bedre smertebehandling. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1114-5. [DOI: 10.4045/tidsskr.15.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lindberg MF, Grov EK, Gay CL, Rustøen T, Granheim TI, Amlie E, Lerdal A. Pain characteristics and self-rated health after elective orthopaedic surgery - a cross-sectional survey. J Clin Nurs 2013; 22:1242-53. [DOI: 10.1111/jocn.12149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Maren F Lindberg
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Ellen K Grov
- Department of Nursing Science; Faculty of Medicine; University of Oslo; Blindern Oslo Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing; University of California; San Francisco CA USA
- Department of Research and Development; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care; Department of Research and Development; Oslo University Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
| | - Tove I Granheim
- Postoperative Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Einar Amlie
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Anners Lerdal
- Department of Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
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Rognstad MK, Fredheim OMS, Johannessen TE, Kvarstein G, Skauge M, Undall E, Rustøen T. Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards. Scand J Caring Sci 2012; 26:545-52. [DOI: 10.1111/j.1471-6712.2011.00964.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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