An innovative nonpharmacological intervention combined with intravenous patient-controlled analgesia increased patient global improvement in pain and satisfaction after major surgery

doi:10.2147/NDT.S131517

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Title:	An innovative nonpharmacological intervention combined with intravenous patient-controlled analgesia increased patient global improvement in pain and satisfaction after major surgery
Authors:	Chuang, Chia-Chun Lee, Chien-Ching Wang, Li-Kai Lin, Bor-Shyh Wu, Wen-Ju Ho, Chung-Han Chen, Jen-Yin
Contributors:	Department of Anesthesiology, Chi Mei Medical Center Department of Imaging and Biomedical Photonics, National Chiao Tung University Department of Medical Research, Chi Mei Medical Center Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science
Keywords:	acute pain service patient-physician communication nonpharmacological approach patient-controlled analgesia patient satisfaction
Date:	2017
Issue Date:	2018-11-30 15:54:46 (UTC+8)
Publisher:	Dove Medical Press Ltd
Abstract:	Purpose: This study aimed to evaluate whether a nonpharmacological approach through implementation of a communication improvement program (named CICARE for Connect, Introduce, Communicate, Ask, Respond and Exit) into standard operating procedure (SOP) in acute pain service (APS) improved satisfaction in patients receiving intravenous patient-controlled analgesia (IV-PCA). Patients and methods: This was a nonrandomized before-after study. Adult patients (aged between 20 and 80 years) who received IV-PCA after major surgery were included. Implementing CICARE into SOP was conducted in APS. Anonymous questionnaires were used to measure outcomes in this prospective two-part survey. The first part completed by APS nurses contained patients' characteristics, morphine dosage, delivery/demand ratios, IV-PCA side effects and pain at rest measured with an 11-point numeric rating scale (NRS, 0-10). A score of NRS. 4 was defined as inadequately treated pain. The ten-question second part was completed by patients voluntarily after IV-PCA was discontinued. Each question was assessed with a 5-point Likert scale (1: extremely poor; 5: excellent). Patients were separated into "before" and "after" CICARE groups. Primary outcomes were patient global impression of improvement in pain (PGI-Improvement) and patient satisfaction. Secondary outcomes included quality of communication skills, instrument proficiency and accessibility/availability of IV-PCA. Results: The response rate was 55.3%, with 187 usable questionnaires. CICARE effectively improved patient global impression of improvement in pain, patient satisfaction, communication skills and accessibility/availability of IV-PCA. No significant differences were noted in instrument proficiency, morphine dosage, delivery/demand ratios, rates of inadequately treated pain at rest and side effects of IV-PCA between groups. Paradoxical findings were noted between the rates of inadequately treated pain/side effects and PGI-Improvement in pain/patient satisfaction, which were affected by psychological factors. Conclusion: Nonpharmacological interventions carried out by implementing CICARE into SOP for APS effectively improved patient satisfaction and postoperative pain management quality, but this did not affect actual pain.
Relation:	Neuropsychiatric Disease and Treatment, v.13, pp.1033-1042
Appears in Collections:	[Dept. of Senior Service and Health Management] Periodical Articles

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