title: Pain management after cardiac surgery: experience with a nurse-driven pain protocol.
abstract: OBJECTIVE
  Management of post-operative pain is important for decreasing post-operative morbidity and mortality. After evaluating our pain score database of patients undergoing cardiac surgery (2007-2009) we revised our pain protocol. The new protocol allows nurses to administer analgesic medication without consulting the attending physician. The setting was a medium care unit, a nursing ward with additional monitoring of heart rate and rhythm. We investigated the effects of this revised pain protocol in a prospective consecutive cohort study.
  
  
  METHODS
  We evaluated 193 patients treated according to the revised protocol (RP group) during the first 72 hours post-cardiac surgery on the medium care unit. A visual analogue scale (VAS) was used as pain scoring system. These patients were compared with a control group (Ctrl group) consisting of 1535 patients.
  
  
  RESULTS
  Patients from the RP group had a mean VAS of 2.2 compared to a mean VAS of 2.8 in the Ctrl group (p < 0.0001). In the Ctrl group 44% of patients with a VAS ≥ 4 maintained this score for 8 hours afterwards. In contrast, in the RP group 81% had a reduction in VAS score within 3 hours. Using the new protocol there were no adverse events requiring intervention such as medication or readmission to an intensive care unit.
  
  
  CONCLUSIONS
  This study shows that in post-cardiac surgery patients a significant reduction in VAS scores can be safely realized by a nurse-driven protocol. Furthermore, a reduction in time to achieve an acceptable pain score (VAS < 4) was realized.
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus Medical Center, the Netherlands. r.vanvalen@erasmusmc.nl
authors.forename: Richard
authors.initials: R
authors.lastname: van Valen
authors.forename: Henriette
authors.initials: H
authors.lastname: van Vuuren
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Dries
authors.initials: D
authors.lastname: van der Woerd
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000451:nursing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000451:nursing*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing*; D013527:Perioperative Nursing / Q000379:methods*; D017009:Professional Autonomy; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics