248 Nurses’ perspectives on postpartum pain management

Abstract

There is variation in postpartum (PP) opioid use based on bedside nurse (RN) that is not explained by patient, delivery, or prescriber factors. Thus, our objective was to evaluate RN training, clinical practices, and perspectives on opioid use for PP pain management. In this survey study, PP bedside RNs at a single, large, academic center were queried about their formal training, clinical practices, and perspectives on PP pain management and opioid use. Survey findings were summarized using descriptive analysis. Of 166 PP RNs at this site, 80 (48%) completed the survey. A majority (77%) reported receiving some formal training on opioid use for pain management, which was largely in the form of online modules (45%) and leadership emails (44%). Almost one third (29%) felt their training was inadequate. Regarding clinical practices, the majority (71% and 70%, respectively) reported that ‘standard habit’ and ‘patient preference’ most influenced the type and amount of pain medication they administered. The majority (94%) felt opioid use is necessary for most patients after cesarean delivery, whereas 5% felt similarly regarding vaginal delivery. Finally, RN perspectives on pain management demonstrated a wide range of beliefs (Figure). Most RNs strongly agreed with the importance of maximizing non-opioid pain medication prior to opioid administration. The majority agreed that patient reported pain score is important to consider when deciding to administer opioids. Conversely, most RNs disagreed that patients should be encouraged to endure as much pain as possible prior to using an opioid. There was a large range of perspectives regarding the impact of opioid use on breastfeeding and patient satisfaction. Similarly, beliefs about the reliability of use of vital signs in assessing pain intensity varied widely (Figure). Bedside RNs rely on standard habit, patient preference, and patient-reported pain score when administering opioids for PP pain management. Increased training opportunities to improve consistency and standardization of opioid administration may be beneficial.