Presentations for STAPG Prize

Standardised analgesic take-home packs for patient’s following orthopaedic day surgery

Biography
Rachel has been a clinical nurse specialist in the pain service at Imperial College Healthcare Trust, since 2003. Previously she worked in the pain service at the Royal Brompton.  She is an active member of the London RCN and Pain Network Group and was the database co-ordinator until recently.  She successfully completed her MSc in pain management at Leicester University in 2005.

Abstract

Introduction
The aim of this 2-part prospective audit was to investigate patients’ experiences of pain following orthopaedic day surgery and to examine whether the introduction of standardised take-home analgesic packs, together with relevant accompanying information leaflets, may help to establish a more effective programme of pain management.  The primary outcome measure was severity of pain in the first 24 hours following surgery.  Secondary measures included interference on sleep and mobility, incidence of side effects and clarity of patient information.

Methods
An exploratory audit of 73 patients was performed to examine how much pain patients experienced in the first 24 hours following various orthopaedic day surgical procedures.  Patients were assessed on admission to ascertain demographic and baseline data.  They were telephoned at home 48 hours after surgery, to determine the outcome of primary and secondary measures.  A questionnaire, based on a previous study investigating pre-packed take-home analgesia after day surgery was used.

Pain assessment scores from the first audit enabled the categorisation of operations into one of three groups, according to pain severity.  Standardised analgesic packs were formulated to correlate with the level of pain in each of these classification groups.  Nurses dispensed the analgesic packs and written information on discharge, according to guidelines.  Following these changes to practice a follow-up audit of 61 patients was conducted, to assess the effectiveness of the take-home analgesia packs.

Results
A significant reduction in pain scores was found following the introduction of the analgesic take-home packs.  A significant improvement was found in patients’ ability to conduct normal activities.  There were no significant differences in sleep, or general mobility.  Despite the higher doses of analgesia prescribed the incidence of side effects did not differ.

Discussion
The introduction of standardised analgesic packs improved pain following orthopaedic day surgery, but other strategies need to be considered to improve pain scores further.  The incidence of nausea was high and it is suggested that take-home packs should also include an anti-emetic for patients at high risk of developing nausea.