279 - Multimodal Pain Management in Orthopedic Surgery: Improving Communication to Improve the Patient Experience
Multimodal Pain Management in Orthopedic Surgery: Improving Communication to Improve the Patient Experience Description of Team Currently, interdisciplinary team members meet with patients scheduled for total knee arthroplasty (TKA) and total hip arthroplasty (THA) joint surgery at a preoperative education session to discuss upcoming surgical intervention. Components of the Enhanced Surgical Recovery (ESR) protocol are discussed including details of the multimodal pain management (MPM) protocol. Preparation and Planning Printed material explaining the essential components of the ESR protocol is available for patients in attendance and discussed by various member of the preoperative team. The visit is divided into two sessions, the first being an interview assessment with a perioperative nurse, lab blood draw, and the introduction into the ESR protocol, and the second being a class on the orthopedic unit where a nurse continues the introduction and review of the ESR protocol, the postoperative phase including physical therapy, dietary, nursing, pain management and discharge planning. Assessment Patient experiences are reported via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, analyzed by Press Ganey, and provided for the hospital to improve the patient experience. Data reported by Press Ganey can be monitored following implementation of the education protocol for outcomes, process gaps, and opportunities for improvement. Data collected in 2018 identified areas related to patient communication with staff on how pain was treated and the degree of pain suffered during hospital stay that would benefit from improvement. Scores on the HCAHPS survey indicated “always” scores in the 65% to 83% which were inconsistent. Following the problem/population, intervention, comparison and outcome (PICO) framework the clinical question becomes “Can staff education focused on improved communication regarding pain management through the MPM protocol improve patient experience scores related to pain communication?” Implementation Staff education related to improving communication regarding pain is underway. The plan includes updating scripts for staff regarding the multimodal pain management protocol and patient education to be distributed to physician offices for those patients planning on TKA and THA surgical intervention. The education for the staff and the patient includes newly introduced material related to Goal-Directed Pain Management (GDPM). This education began in November 2019. Outcome Data collection and analysis continues to establish baseline and evaluation for improvement and revision of the process for improvement. The hypothesis stated is improving staff education related to pain management for the TKA and THA patient will improve patient satisfaction related to communication about pain. Implications for Perioperative Nursing Perioperative nurses strive to improve the patient experience which directly impacts patient safety, patient satisfaction, cost-effective service, and staff satisfaction in their job. To this end, nurses are always in search of better methods, better processes and new applications of evidence-based practice in the clinical setting.