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Scand J Pain. 2017 Apr;15:22-29. doi: 10.1016/j.sjpain.2016.11.006. Epub 2016 Dec 9.

Pain and pain management in hospitalized patients before and after an intervention.

Author information

1
The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Box 457, 405 30 Gothenborg, Sweden; Department of Medicine, Hallands Hospital, Varberg, Träslövsvägen 68, 432 37 Varberg, Sweden. Electronic address: viveka.andersson@regionhalland.se.
2
Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenborg, Sweden; Spenshult Research and Development Centre, Bäckagårdsvägen 47, 302 74 Halmstad, Sweden. Electronic address: stefan.bergman@gu.se.
3
The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Box 457, 405 30 Gothenborg, Sweden; Angered Local Hospital, Halmtorget 1, 424 65 Gothenburg, Sweden. Electronic address: ingela.henoch@gu.se.
4
Department of Research, Development and Education, Hallands Hospital, Varberg, Träslövsvägen 68, 432 37 Varberg, Sweden.
5
Department of Anesthesia and Intensive Care, Hallands Hospital, Varberg, Träslövsvägen 68, 432 37 Varberg, Sweden.
6
Department of Surgery, Hallands Hospital, Halmstad, Lasarettsvägen, 302 33 Halmstad, Sweden. Electronic address: hanna.simonsson@regionhalland.se.
7
The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Box 457, 405 30 Gothenborg, Sweden. Electronic address: karin.ahlberg@gu.se.

Abstract

BACKGROUND AND AIM:

Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.

METHODS:

A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.

RESULTS:

When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4-10) and at follow-up that figure was 24% (NRS 4-10). In both surveys, 41% reported moderate to severe pain (NRS 5-10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.

CONCLUSIONS:

This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.

IMPLICATIONS:

Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.

KEYWORDS:

Acute pain; Analgesia; Cancer pain; Chronic pain; Pain management; Pain organisation

PMID:
28850341
DOI:
10.1016/j.sjpain.2016.11.006
[Indexed for MEDLINE]

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