title: Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design.
abstract: BACKGROUND
  Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described.
  
  
  METHODS
  In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed.
  
  
  CONCLUSIONS
  The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts.
authors.affiliation: Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia. mari.botti@deakin.edu.au.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.forename: Bridie
authors.initials: B
authors.lastname: Kent
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.forename: Maxine
authors.initials: M
authors.lastname: Duke
authors.forename: Megan-Jane
authors.initials: MJ
authors.lastname: Johnstone
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.forename: Bernice
authors.initials: B
authors.lastname: Redley
authors.forename: Susan
authors.initials: S
authors.lastname: Hunter
authors.forename: Richard
authors.initials: R
authors.lastname: de Steiger
authors.forename: Marlene
authors.initials: M
authors.lastname: Holcombe
authors.forename: Emma
authors.initials: E
authors.lastname: Cohen
mesh_terms: D000465:Algorithms; D000700:Analgesics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008485:Medical Audit; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D015203:Reproducibility of Results; D012107:Research Design
chemical_list: D000700:Analgesics