[Editor’s note: Amy Smalarz led the survey research. Lynn Razzano assisted with the article writing, but was not involved with the design, conduct, or analysis of the survey.]
By Amy Smalarz PhD, MHA (President and Co-Founder, Strategic Market Insight) and Lynn Razzano RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)
Postsurgical pain management with opioids is tricky business. Not only do you have to think about which medication delivery interventions to use (PCA IV opioids, continuous wound infiltration, continuous epidural or femoral nerve block to name a few), but you must consider the type and amount of medication, then responsibly monitor the patient effectively. We know all too well about the dangers and challenges of ensuring the effectiveness of the medication as well as the safety of the patients; for example, The Joint Commission issued Sentinel Event Alert #49 and the Institute for Safe Medication Practices recently issued yet another Medication Safety Alert.
Delivery of and monitoring patients on opioids is primarily the responsibility of nurses. Nurses are the front-line providers for the patients in the inpatient postsurgical setting and are chiefly responsible for the execution of postsurgical pain management orders and protocols. However, given all of the research supporting the financial and clinical burden of opioids, the Sentinel Event Alert #49 and Medication Safety Alerts, very little is documented about nurses’ awareness of opioids and their related adverse events or how nurses’ time is spent in postsurgical care, specifically the impact and influence of particular postsurgical pain management medication interventions (PSMIs). Therefore, we took it upon ourselves to ask.
In July, we wrote about nurses’ level of opioid awareness in 5 Findings From an Opioid Awareness Survey Conducted at AORN Annual Conference. As we reported, the results of this survey demonstrate that while nurses are aware of some safety concerns and issues regarding opioid use, an opportunity exists to educate nurses about opioid adverse events, potential unnecessary use as well as opioid long-term use and potential addiction.
In order to gain insight into nurses’ perception of the impact of PSMIs, we expanded the audience of the survey and in a recently conducted survey, we sought to answer the following questions:
- What are nurses’ perceptions of postsurgical pain management interventions (modalities)?
- How do nurses feel they are able to deliver patient care on the floor or unit?
Most importantly, we included nurses and their perspectives on the impact of providing care in the inpatient postsurgical setting.
Detailed results of this survey are forthcoming (upon manuscript publication); however, we can report that the choice of PSMI can negatively impact nurses’ time spent with patients as well as present barriers that interfere with nurses and their ability to provide direct patient care. In addition, we found that while 75% of the respondents (305 nurses) reported having an acute pain service in their hospital, on 15% of those are led by nurses and over 75% are led by anesthesiologists. Given their proximity to patients and patient care, and responsibility for the execution of postsurgical pain management orders and protocols, it is important for nurses to take an increased proactive and leadership role in acute pain services within their facilities.
Our study was novel in its approach as we talked to nurses – asking them directly about the influence of PSMIs. Future research is needed to explore and further clarify the nature of relationship of PSMIs, nursing time spent on direct patient care and both the positive and possible negative, financial and clinical outcomes.
We want to take a deeper dive into the exploration of the relationship between the variables included in this study, such as nursing experience and time spent and/or level of interference distractions they face in every day clinical practice. We also need to explore the role of the leader of the acute pain service and time spent and/or level of interference or distractions. Some of the additional variables we need to collect in perioperative and surgical units include:
- The presence of quality improvement initiatives,
- Patient satisfaction scores,
- Identifying the volume and severity of distractions in work flow processes
- Whether nurses are active participants in their acute pain services programs,
- The culture of the institution.
Two additional areas of research would be to examine, whether either of the following affects, nurses’ awareness of opioids as well as their perceived impact on time spent and level of interference with direct patient care:
- An opioid-specific staff educational program in order to provide uniform and consistent education, and
- Inclusion of nurses in leadership roles for acute pain service programs.
Nurses are the point of care delivery directly to the patient’s and are affected daily by the time spent in the care of the patient. How care is delivered on the floor or unit is related to work flow and very intricate processes – and only nurses have expert knowledge in this area. Their perceptions help to isolate the value of the work flow and what is needed to monitor patients that are receiving opioids, whatever method of delivery may be.
As hospitals and other healthcare facilities look to make changes to management of patients receiving pain management, not asking nurses is a dangerous mission impossible if one wants to gain insight and workable knowledge of what most impacts them and their actual care delivery to patient in need of post-surgical pain management.