Developing 'subject matter experts': an improvement methodology programme for acute postoperative pain with patients post major surgery.

Abstract

To determine the effectiveness of an improvement methodology initiative, directed at refining the quality of acute pain management of patients in the first 24hours post major surgery using the Revised American Pain Society Patient Outcome Questionnaire, pre- and post development of a 'subject matter experts' acute pain programme. Accurately measuring effectiveness of acute pain management post major surgery is intertwined with measuring overall patient satisfaction. A critical element of quality evaluation is obtaining direct feedback from patients about the here-and-now pain experiences post major surgery. A prospective cross-sectional, observational study was conducted in a large university hospital in Ireland. The questionnaire was completed with patients within 24hours post major surgery, i.e., cardiothoracic, breast, gynaecological, gastrointestinal and urology surgery. The nurse participants were selected based on their commitment to play a key role in acute pain management. The study consisted of: a pre programme phase (n=100 patients), an intervention phase - 'subject matter experts' acute pain programme (n=24 nurses) and a postprogramme phase (n=100 patients). Over a quarter of patients were in severe pain for long periods in the first 24hours post major surgery. These findings were linked not only to ineffective analgesia from some pain drug therapies but also to contradictory messages from nurses. Over half of the patients' pre- and postintervention reported satisfaction with acute pain management, whereas the remainder were dissatisfied and some sought answers to their suboptimum pain status. The 'subject matter experts' had a noteworthy impact on the patients' pain beliefs. The findings revealed that a 'subject matter experts' acute pain programme can have a positive impact on pain management in the immediate phase post major surgery. The role making of 'subject matter experts' in acute pain is a tactical approach towards achieving optimum patient pain control in the immediate phase post major surgery.