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Pain Management

This project outlines an audit of patient-controlled oral analgesia (PCOAH) practices at Wairau Hospital, assessing patient experiences and pain management effectiveness post-surgery. The audit cycle involved identifying issues, reviewing literature, and implementing required changes. Key findings from the patient experiences over 48 hours post-surgery indicate variations in pain relief, analgesic consumption, and overall satisfaction. The multidisciplinary approach emphasizes collaboration and ongoing feedback to enhance PCOAH practices, ensuring safer, more effective pain management for patients.

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Pain Management

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  1. Pain Management

  2. Patient Controlled Oral Analgesia at Home (PCOAH) Dr Jeremy D Stevens Consultant Anaesthetist Wairau Hospital Blenheim

  3. Introduction • AUDIT CYCLE (revision) • Problem identified • Audit of current practice & literature review • Analyse & discuss need for change • Institute change of practice • Re-audit & review • Repeat as necessary • The project/audit – ‘Pain and Emesis experiences at home after day surgery for 48 hours’ (UK) • Poster • Publication • PHO web-site

  4. The UK Project • Problems highlighted – early 1996 * • Multidisciplinary approach * • Audit of current practice – late 1996 • Standardised questionnaire (article) • Literature review – international • No standards • Change of practice – early 1997 • Re-audit – late 1997 • Presentations – 1998 • Publications – 1999

  5. UK – Change of Practice • Simplify / standardise • Evidence based / balanced analgesia • Pack design 1 & 2 • Information and self administration leaflet • Decision: ‘Which pack type?’ (NSAID sensitivity) • Prescribing simplified: Pack 1 or 2 • Administration by day care nurses prior to discharge • ‘Free’ to the patient; part of contract for the operation • 5 day supply

  6. NZ Project (so far) • Same issues raised – late 2007 • UK tool applied for audit – 2008/2009 • Multidisciplinary team working model

  7. RESULTS

  8. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMERESPONSE & SAMPLE CHARACTERISTICS

  9. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENTS IN MODERATE OR SEVERE PAIN

  10. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC CONSUMPTION & EFFECTIVENESS (1)

  11. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC CONSUMPTION & EFFECTIVENESS (2)

  12. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEANALGESIC EFFECTIVENESS

  13. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT OUTCOMES (1)

  14. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT OUTCOMES (2)

  15. WAIRAU DAY SURGERY AUDIT – PATIENT EXPERIENCES AT HOMEPATIENT SATISFACTION(NZ Audit Only)

  16. Results Summary • Better response • Older ages • Less moderate – severe pain – Consultant service? • Less analgesics supplied • Initial operation day less taken • Less total relief on first day post-op • More sleep disturbance second day post-op • Intermediate information supplied • Overall more contact post-op > 30% pain • Good contact details supplied/functional • Good patient satisfaction

  17. Questions • Is change warranted? Is there a problem? • If change in practice – what? • Similar to UK model? • NZ design? • Multidisciplinary approach? – DEFINITELY • COLLABORATIVE FEEDBACK REQUIRED • Contact - jeremy.stevens@nmdhb.govt.nz

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