Category: Professional Posters
Purpose: As a Joint Commission International certificated healthcare agency, Beijing United Family Hospital adopts particularly serious attitude towards pain management. From June 2018, Beijing United Family Hospital initiated a pain-range order analgesic protocol regarding to World Health Organization analgesic ladder in general surgical post-operative patients. However, adoption of stepwise approach of World Health Organization analgesic ladder to post-operative pain management has been questioned by various healthcare professionals. The goal of this research was to evaluate the effectiveness of a range order analgesic approach for patients after laparoscopic appendectomy, a minor to intermediate minimally invasive procedure.
Methods: This is a retrospective study of patients who were hospitalized more than 24 hours after laparoscopic appendectomy at Beijing United Family Hospital, where a pre-intervention group (54 consecutive patients) from June 2017 to May 2018 is compared to a post-intervention group (42 consecutive patients) from June 2018 to May 2019 after implementation of pain range order analgesic protocol on pro re nata analgesics orders. Population who were under 12 years old or older than 65 years old, either underwent per-operative pain or chronic pain were excluded from this study. Data collected included patient demographics, operation length, post-operatively hospitalization length and pain score and so on. Patient pain assessments were performed every 0.5 hours to 2 hours. The primary outcomes are the times of moderate-to severe pain within post-operative 24 hours, average time of moderate-to-severe pain in each patient. A survey of attitude and practice of analgesic use in post-operative patients among medical staffs in general surgical ward was conducted.
Results: The proportion of patients who experienced moderate- to-severe pain (Visual Analog Scale 4-10) post-operatively decreased after implemetation of range order analgesic protocol: 63 percent versus 48 percent. The average times of undergoing moderate-to-severe post-operative pain within 24 hours was decreased from 1.46 (n equals 34) to 1.14 (n equals 20). Average post-operatively hospitalized length decreased from 47 hours to 42 hours. Nursing staff attitude surveys of pre-/post- intervention revealed standardized pain range order reduced burden of decision making and standardized interpretation of pro re nata analgesic orders.
Conclusion: These findings illustrate pain-range order analgesic protocol improves post-operative pain management of laparoscopic appendectomy patients. Study such as patient satisfaction survey on post operative pain management will be done in the future.