[Pain management in surgical wards. Quality and solutions for improvement in the early postoperative period].
BACKGROUND
Following guidelines pain levels should not exceed a score of 3 on the visual analog scale (VAS 1-10). We were interested in the actual surgical pain management of the postoperative period and the potential influences of a nurse-controlled intravenous morphine administration (NCA) on its quality.


METHODS
Interventional study: interview of patients and nursing staff and examination of records concerning pain treatment following surgery.


RESULTS
The interviews were conducted with 110 patients before and 125 patients after the intervention program. Before the intervention, one-half of the patients noted that they were never asked about their pain intensity within the first 24 h after surgery. Only 42% of the records showed at least one VAS documentation. Every fourth individual experienced a pain intensity > 3 without having received a supplementary pain medication. Following the morphine intervention program, documentation of pain scores increased significantly (72%; p < 0.0001) and more patients were familiar with the VAS (64% vs 46%; p < 0.0004). Median maximum as well as actual pain at the time of the interview decreased by one point (VAS). The percentage of patients whose supplementary pain prescription was totally used showed a significant increase (p = 0.035). Following morphine administration, no single individual complained about an undue waiting time in comparison to 15% of patients previously. Even though the morphine intervention project caused more work for the nursing staff, 75% of the personnel were convinced that the procedure was worth this investment.


CONCLUSIONS
This data revealed a relevant deficiency of surgical pain management. Already basic instructions on pain management can significantly improve this treatment. Assigning additional authority to the nursing staff, such as a nurse-based intravenous opioid administration, can significantly raise the motivation of the personnel as well as the satisfaction of the patients involved.
Gross
T
T
Allgemeinchirurgische Klinik, Department Chirurgie, Universität Basel, Spitalstrasse 21, 4031 Basel, Schweiz. tgross@uhbs.ch
Pretto
M
M
Aeschbach
A
A
Marsch
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing; D017060:Patient Satisfaction; D011446:Prospective Studies; D011787:Quality of Health Care
D000701:Analgesics, Opioid; D009020:Morphine