Improving management of pain in opioid tolerant orthopedic surgical joint replacement patients - a poster board presentation

Unrelieved post-operative pain can lengthen recovery time, decrease patient satisfaction and increase the cost of care. At Kaiser Hawaii, the pain and nursing services became aware that opioid tolerant orthopedic joint replacement patients had often had poor pain control. Considerable time was spent managing pain in these patients. Recognizing the opportunity for improvement, a team was created to identify the best practice with pain management in orthopedic surgical patients who are opioid tolerant. Working with the Hawaii State Center for Nursing, the Iowa Model of Evidence Based Practice to Promote Quality Care was used to guide the project. A multidisciplinary team was formed to represent care across the continuum from the orthopedic clinic prior to surgery, through the pre-op and post-op care, into the hospital experience and through discharge. An extensive literature review indicated that early patient identification should be part of the nursing assessment. Seamless communication across the phases of care is essential and supports the multidisciplinary team approach. A pilot study is currently in progress. Projected finish date of the pilot is the end of December, 2012. The intended outcome is a guideline with recommendations for patient identification, multidisciplinary communication and optimization of care. Ultimately, this will result in improved post-operative pain levels, decreased length of stay in the recovery room and hospital and will lead to improved patient satisfaction.