Management of acute postoperative pain in Australian hospitals - room for improvement
Taylor, DR and Loh, SF and Mulligan, KT and Pulver, LK and Tompson, AJ and Wai, A, Management of acute postoperative pain in Australian hospitals - room for improvement, Journal of the Australasian Association for Quality in Health Care, 2010, (Summer) pp. 29-36. ISSN 1440-2599 (2010) [Refereed Article]
Objective: To describe a quality improvement initiative in the management of acute postoperative pain in Australian
Design: Multicentre, cross-sectional, retrospective inpatient medical record review and post-discharge surveys of patients
and their General Practitioners (GPs), conducted between October 2006 and October 2007, before and after targeted
Setting: 62 Australian hospitals - representing the spectrum of regional/remote to principal referral and including private
and specialist hospitals.
Participants: Up to 50 adults undergoing emergency/elective surgery per hospital, in each of baseline and follow-up
Outcome measures: Documented preoperative education; pain and sedation assessment; safe and effective analgesic
prescribing and communication of a pain management plan to patients/carers and their GPs at discharge.
Results: 2704 baseline (2780 follow-up) patients were included. Documentation of preoperative education regarding
postoperative pain was noted for 31% (44%) of patients. 57% (76%) of patients had at least one pain score documented in
the postoperative data collection period. Of patients prescribed analgesia, 68% (74%) were prescribed regular paracetamol
and 23% (18%) only as needed analgesia. Of patients prescribed opioids, 50% (61%) had at least one documented sedation
score and 87% (90%) were prescribed an antiemetic agent. Discharge pain management plans were documented for 26%
(40%) of patients and of these, 86% (87%) were communicated to patients and 71% (77%) to GPs.
Conclusions: Targeted interventions including one-on-one educational visiting and feedback of comparative data improved
some key outcome measures; performance and documentation of preoperative education, post-operative pain and adverse
event assessment and discharge communication with patients and GPs.
postoperative pain, quality improvement, continuum of care