When patients are kept comfortable and free from pain in the hours and days after surgery, they tend to rate their overall hospital experience higher. This is the conclusion reached by researchers earlier this year, in an analysis that retrospectively compared patients’ pain scale scores with the satisfaction ratings gathered by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
HCAHPS, which is usually pronounced as H-Caps, is a survey instrument that aims to measure patient satisfaction with the entire hospital experience. Recently discharged patients are asked to answer roughly 30 questions, in seven key topic areas that include responsiveness of hospital staff, nursing communication skills, physician communication skills, pain management, quietness and cleanliness, explanations about medications, and discharge instructions. The survey is designed to allow objective and meaningful comparisons between hospitals, in areas that are important to consumers.
It is especially revealing that patients’ perceptions of pain management have such a huge impact on their global perception of the entire hospital stay. The study authors concluded that hospitals could improve their overall HCAHPS scores, which can affect reimbursement, by increasing their focus on pre-admission, pre-operative, and intra-operative interventions that address pain, as well as making changes to the way care is delivered in the PACU.
So what can nurses do to help patients manage post-op pain? While you’re obviously bound by established policies at your hospital, you can also speak up and work to change current protocols if you believe them to be deficient. When it comes to post-op pain, here are a few things to keep in mind.
- Assessment tools should be evidence-based. Pain is subjective, making it difficult to measure. Yet a variety of pain measurement approaches are in use –including verbal descriptions, numeric self-rating scales, behavioral observations, and physiological responses. When you learn more about assessing pain, you can better advocate for your patient.
- Pre-operative assessment is key. Nurses can use information gathered in pre-op assessments to help plan successful post-op treatment. The patient’s medication history, along with any ongoing complaints of chronic pain, can help determine the medications and dosages used post-op. Using an assessment tool to measure pre-op pain levels can also teach the patient how to respond, while helping to set expectations.
- Medication responses vary with the individual. Research shows that the way in which patients respond to opioids is partly genetic. Patients metabolize different drugs at different rates, and fast metabolizers will need larger doses. There is also a lot of variation in the receptor cells that opioids bind to, and that can also determine a patient’s individual response to a specific drug. Men and women also respond differently to various analgesics, based on differences in hormones and body fat percentages between the genders.
- PCA pumps increase patient satisfaction. Nurses who work with post-op patients should acquire proficiency with patient-controlled analgesia. They should know about standardized medication concentrations, patient selection criteria, how to program and operate the pump, and how to monitor patients using PCA for adverse effects.
- Non-pharmacological pain management techniques can help. The American Pain Society recommends that providers become familiar with a variety of physical and psychological pain management modalities. These can range include distraction, music therapy, active listening, relaxation and breathing exercises, ice packs, heating pads, and massage. As frontline patient advocates, nurses should become familiar with all techniques that can provide comfort and reduce stress for post-op patients.
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