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Pain Management in the Surgical/Trauma Patient

Pain Management in the Surgical/Trauma Patient. Antoinette McNeil, BSN, RN, CCRN Analysis of Evidence-Based Practice Professor: Chioma N wachukwu, DNP, RN 2012. Introduction. There are over 77 million people suffering from pain HCAPHS score 63-74% pain controlled

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Pain Management in the Surgical/Trauma Patient

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  1. Pain Management in the Surgical/Trauma Patient Antoinette McNeil, BSN, RN, CCRN Analysis of Evidence-Based Practice Professor: Chioma Nwachukwu, DNP, RN 2012

  2. Introduction • There are over 77 million people suffering from pain • HCAPHS score 63-74% pain controlled • Pain is what the patients states and occurs where the patient say is does • Complications of unmanaged pain • Goal of pain management

  3. Nursing Theory/Model • Leininger’s Theory: Culture, Care Diversity and Universality • Care is focus and essence of nursing • Culture care expression diverse but has commonalities that exist • Understand patient’s culture • Nurses needs to look at their beliefs and values as they care for patients in other cultures

  4. Impact of Problem • Cost of lost workdays exceeds $100 billion yearly • Medicare cost exceeds $124 million yearly for pain treatment and disability cost for chronic pain • Increase risk of morbidity and mortality from • Pneumonia • DVT • Pulmonary Emboli • Myocardial Infarction • Confusion • Chronic Pain

  5. Multidisciplinary Approach

  6. Nursing assessing and reassessing for pain • Nurses administering pain medication around the clock • Physicians ensuring that patients pain is managed properly and assist in improving practice • Anesthesiologist responsible for 24 hours for post-operative pain management • Leadership and Administration to provide administrative and financial support for pain management plan

  7. Evidence-Based Practice • Use of acetaminophen and or NSAID’s before surgery • Epidural analgesia • Bupivacaine collagen sponges • Elastomeric pumps • Fentanyl iontophoretic transdermal system

  8. Methods to Improve Pain Management • Patient education • Physician education • Pharmacist education • Physical and Occupational therapy education • Nursing education

  9. Evaluation and Conclusion • HCAHPS survey • Length of stay • Complications • Working together

  10. Reference • Bernhofer, E. (2012, January). Ethics: Ethics and Pain Management in Hostpiralized Patients. The Online Journal of Issues in Nursing, 17. http://dx.doi.org/10.3912/OJIN.Vol17No01EthCol01 • Dihle, A., Bjolseth, G., & Helseth, S. (2006). The gap between saying and doing in postoperative pain management. Journal of Clinical Nursing, 15(), 469-479. • Dusek, J. A., Finch, M., Plotnikoff, G., & Knutson, L. (2010, March). The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hosptial. Journal of Patient Safety, 6(1), 48-51. • D’Arcy, Y. (2011). Compact Clinical Guide to Acute Pain Management An Evidence-Based Approach for Nurses. New York, NY: Springer • Goodman, G. R. (2003, April-June). Outcomes Measurement in Pain Management Issues of Disease Complexity and Uncertain Outcomes. Journal of Nursing Care Quality, 18(2), 105-111 • Layzell, M. (2008, April 10). Current interventions and approaches to postoperative pain management. British Journal of Nursing, 17(7), 414-419. • Leegaard, M., Watt-Watson, J., McGillion, M., Costello, J., Elgie-Watson, J., & Partridge, K. (2011, July/August). Nurses’ Educational Needs for Pain Management of Post-Cardiac Surgery Patients A Qualitative Study. Journal of Cardiovascular Nursing, 26(4), 312-320.

  11. McCreaddie, M., Lyons, I., Watt, D., Ewing, E., Croft, J., Smith, M., & Tocher, J. (2010). Routines and rituals: a grounded theory of the pain management of drug users in acut care settings. Journal of Clinical Nursing, 19(), 2730-2740 • Megens, J. H., Van Der Werff, D. B., & Knape, J. T. (2008, July). Quality improvement: implementation of a pain management policy in a university pediatric hospital. Pediatric Anesthesia, 18(7), 620-627 • Mularski, R. A., White-Chu, F., Overbay, D., Miller, L., Asch, S. M., & Ganzini, L. (2006, June). Measuring Pain as the 5th Vital Sign Does Not Improve Quality of Pain Management. Journal of General and Internal Medicine, 21(6), 607-612. • Napierr, D. E., & Bass, S. S. (2007, November/December). Postoperative Benefits of Intrathecal Injection for Patients Undergoing Total Knee Arthroplasty. Orthopaedic Nursing, 26(6), 374-378 • Reimer-Kent, J. (2004, October). Improving Post-oprative Pain Management by Focusing on Prevention. Nursing BC, 20-24. • Sagar, P. L. (2012). Transcultural Nursing Theory and Models. New York, NY: Springer . • Vega-Stromberg, T., Holmes, S. B., Gorski, L. A., & Johnson, B. P. (2002, October). Road to Excellence in Pain Management: Research, Outcomes and Direction (ROAD). Journal of Nursing Care Quality, 17(1), 15-26 • Woodward, D. (2005, July-September). Developing a Pain Management Program Through Continuous Improvement Strategies. Journal of Nursing Care Quality, 20(3), 261-267.

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