[Optimizing postoperative pain therapy on acute surgical wards]

The aim of this interdisciplinary project was the improvement of postoperative pain management on surgery wards of an university hospital: Pain medication should be enlarged with the possibility to administer an opium-medication i.v. (non only s.c.) when needed (VAS > 3), which has been tested on two wards. The study shows the resulting changes of the intervention for patients and nurses. For recording, there has been patient questionnaires and document analysis before and after the new possibility to administer medication, and a nurses opinion survey.

110 resp. 125 patients and 39 nurses have been interviewed. Although there were only few patients (8%) during the second registration who did get the morphine i.v., there were clear tendencies: More patients have been asked about their pain-intensity and recognized the visual analog scale (VAS) (p = 0.0004) and less patients found, that they had to wait for a pain-medicament too long. There was a significant reduction of maximal pain-scores (p = 0.02) and also a significant improvement of nursing supplementary pain medication (p = 0.035). Actual pain-scores and use of basis-analgesia were slightly reduced resp. improved with the intervention. Overall patient-satisfaction regarding the treatment of their pain was high in both groups (> 95%). Nurses found (88%), that the new possibility to administer the morphine i.v. when needed, was good, even though this intervention and the controls of the vital signs requires more work. They said, that very often, it is worth the extra work, and for 31% of them, the focus on pain became more important through the intervention.

The enlargement to administer pain medication and asking/registering pain intensity regularly, created more sensitivity for the patient's pain-experience among nurses, and this lead to better use of the prescribed pain medication and to better pain management overall. Further quality-improvement in post-operative pain relief seems possible by continuing on that way in the future.