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

Authors

  • LENA GUNNINGBERG RN, PhD,

    1. Leader of Nursing Research and Development, Surgery Division, University Hospital
    2. Senior Lecturer, Department of Surgical Sciences, Uppsala University, Uppsala
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  • EWA IDVALL RN, PhD

    1. Scientific Tutor, Research Section, County Council Kalmar
    2. Senior Lecturer, Department of Medicine and Care, Division of Nursing Science, Linköping University, Linköping, Sweden
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Lena Gunningberg
Surgery Division Ing 226
University Hospital
SE 751 85 Uppsala
Sweden
E-mail: lena.gunningberg@akademiska.se

Abstract

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.

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