Contemporary staffing-mix changes: The impact on postoperative pain management

While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12-hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.

Download Full-text

The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

BMC Health Services Research ◽

10.1186/s12913-021-06819-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eva Angelini ◽

Axel Wolf ◽

Helle Wijk ◽

Helena Brisby ◽

Adad Baranto

Keyword(s):

Health Care ◽

Organizational Culture ◽

Pain Management ◽

Postoperative Pain ◽

Spine Surgery ◽

Resistance To Change ◽

Postoperative Pain Management ◽

Assessment Instrument ◽

Systematic Change ◽

The Impact

Abstract Background Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit. Methods The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics. Results The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time. Conclusion It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change.

Download Full-text

Electronic Ordering System Improves Postoperative Pain Management after Total Knee or Hip Arthroplasty

Applied Clinical Informatics ◽

10.4338/aci-2014-12-ra-0114 ◽

2015 ◽

Vol 06 (03) ◽

pp. 591-599 ◽

Cited By ~ 4

Author(s):

T. Chiu ◽

S. Wolfe ◽

S. Magid ◽

M.K. Urban

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Hip Arthroplasty ◽

Postoperative Pain Management ◽

Conventional Group ◽

Delivery Times ◽

Pain Scores ◽

Time To Initiation ◽

Total Knee ◽

The Impact

Summary Objectives: The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system. Methods: Two groups of patients after a total hip (THA) or knee arthroplasty (TKA) were retrospectively compared: one comprising 106 patients when the paper-based ordering system was in effect (conventional group), and one comprising 96 patients after CPOE was installed (electronic group). All patients received a regional anaesthetic at surgery (combined spinal-epidural). TKA patients also received a single-injection femoral nerve block. After transfer to the postoperative anaesthesia care unit (PACU), a patient-controlled epidural analgesia (PCEA) infusion was initiated. The following data was collected from the PACU record: time to initiation of analgesia, visual analog scale (VAS) pain scores at initiation of analgesia and hourly for the first postoperative day (POD), volume of pain medication used, length of stay (LOS) in the PACU and the hospital. Results: The time to initiation of analgesia from arrival in the PACU was significantly lower in the electronic group compared to the conventional group (24.5 ± 28.3 minutes vs. 51.1 ± 26.2 minutes; mean ± SD, p < 0.001), as were VAS pain scores (0.82 ± 1.08 vs. 1.5 ± 1.52, p < 0.001) and the volume of PCEA needed to control pain (27.9 ± 20.2 ml vs. 34.8 ± 20.3 ml, p = 0.001) at 4 hours postoperatively. PACU LOS and hospital LOS did not significantly differ in the two groups. Conclusions: After implementation of CPOE, patients received their postoperative analgesia faster, had less pain, and required less medication. Citation: Urban M,Chiu T, Wolfe S, Magid S. Electronic Ordering System Improves Postoperative Pain Management after Total Knee or Hip Arthroplasty. Appl Clin Inform 2015;6: 591–599http://dx.doi.org/10.4338/ACI-2014-12-RA-0114

Download Full-text

The Impact of an Acute Pain Service on Postoperative Pain Management

Anaesthesia and Intensive Care ◽

10.1177/0310057x9902700408 ◽

1999 ◽

Vol 27 (4) ◽

pp. 375-380 ◽

Cited By ~ 35

Author(s):

J. B. Sartain ◽

J. J. Barry

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Acute Pain ◽

Postoperative Pain Management ◽

Acute Pain Service ◽

The Impact

Download Full-text

Educational Intervention for Effective Postoperative Pain Management in Low Resource Settings: Evidence from Ethiopia

10.21203/rs.2.171/v1 ◽

2019 ◽

Author(s):

Million Tesfaye Eshete ◽

Petra I. Baeumler ◽

Markos Tesfaye ◽

Yemane Ayele ◽

Abraham Haileamlak ◽

...

Keyword(s):

Decision Making ◽

Pain Management ◽

Postoperative Pain ◽

Pain Intensity ◽

Educational Intervention ◽

Patient Reported Outcomes ◽

Postoperative Pain Management ◽

Control Group ◽

Patient Reported ◽

The Impact

Abstract Background The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. Healthcare professionals and patients in education might help in controlling postoperative pain effectively. However, data from low-income countries investigating the impact of educational intervention on postoperative pain are very scanty, and reports from the developed settings are inconclusive. The study has investigated the impact of preoperative patient education and health care professionals education on improving the quality of postoperative pain management; in patients scheduled for major elective orthopedic, gynecologic and general surgery; as measured by patient-reported outcomes. Methods This was a quasi-experimental, non-equivalent control group design with before and after measures. We have recruited 700 consecutive patients; who are eighteen years or more, scheduled for general, orthopedic and gynecologic surgery. Outcome measures were patient-reported outcomes (postoperative pain intensity, pain interference, and perception of care) and adequacy of pain management used. Results Generally, no significant difference was observed in most outcome measures except for the worst level of pain, least level of pain, patient participation in decision making and feeling of drowsiness between the treatment and control group. Conclusion Results of this study contained very important information in understanding the effectiveness of educational interventions in the postoperative setting. The treatment was successful in increasing patients participation in decision making, as anticipated. However, its impact on decreasing pain intensity was only noted at the last measurement point after surgery.

Download Full-text