Implementation of a Pain Management Checklist to Improve Postoperative Pain in Adult Surgical Patients

Effective postoperative pain management is a cornerstone for optimizing patient outcomes and enhancing overall patient satisfaction. The purpose of this quality improvement (QI) project was to decrease postoperative pain in the postanesthesia care unit (PACU) for patients undergoing exploratory laparotomy, noncervical spine, gynecologic, and prostatectomy surgeries by implementing a PAIN management checklist into clinical practice. This QI project aimed to implement a PAIN management checklist to reduce postoperative pain scores among four surgical populations at a large level two hospital.

The Plan-Do-Study-Act QI model was used to guide the project.

The target population was adult patients aged 18 and older, undergoing noncervical spine, gynecologic, prostatectomy, and exploratory laparotomy procedures at level two trauma center. The participants were physician anesthesiologists, Certified Registered Nurse Anesthetists, and PACU registered nurses. After orienting the participants to the project, the PAIN checklist was implemented, and retrospective chart reviews were conducted to gather 3 months of pre- and postimplementation data. The primary outcome measure for this project was pain scores in the immediate postoperative period, as measured by the Numeric Rating Scale.

A total of 1,584 cases were reviewed, 813 preimplementation and 771 postimplementation. The mean pain score upon arrival to the PACU decreased from 1.66 preimplementation to 1.29 postimplementation (P = .03). The mean pain score upon discharge from the PACU increased from 1.94 preimplementation to 2.21 postimplementation (P = .008).

Implementation of the PAIN management checklist resulted in improved pain scores upon arrival to the PACU but did not result in improved pain scores upon discharge from PACU. Future Plan-Do-Study-Act cycles will focus on improving the use of preemptive analgesia by anesthesia staff and the assessment and treatment of pain by PACU staff.