Abstract
The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain. The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management. This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation group. A total of 22 patients received both multimodal analgesia and VR in the post-implementation group. There was no statistically significant difference in total opioid consumption converted as morphine milligram equivalents (MME) between the pre-implementation and post-implementation groups. However, there was a statistically significant difference in multimodal analgesia administered in Pre-op between the pre-implementation and post-implementation groups. In conclusion, the execution of the multimodal analgesic VR program allowed for nursing adoption of novel evidence-based practices (EBP) and promoted the use of non-opioid and non-pharmacological interventions. Although the combination of multimodal analgesia and VR did not reduce opioid consumption, the practice of incorporating multimodal analgesia as a standard workflow improved.
Highlights
In December 2015, clinical practice guidelines emerged on the management of postoperative pain from the American Pain Society, the American Society of Regional Anesthesia, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council (Chou et al, 2015)
Evidence Search Results and Evaluation A review of the literature allowed for an extensive exploration of evidence-based practices (EBPs) to help create a multimodal analgesic virtual reality (VR) program
Anesthesiologists, and surgeons worked together on this project to support the combination of non-opioid, multimodal analgesia and VR as a non-pharmacological intervention
Summary
In December 2015, clinical practice guidelines emerged on the management of postoperative pain from the American Pain Society, the American Society of Regional Anesthesia, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council (Chou et al, 2015). According to one meta-analysis, the authors concluded that VR is a useful pain management tool that reduces acute pain during medical procedures (Mallari, Spaeth, Goh, & Boyd, 2019). The purpose of this Doctor of Nursing Practice (DNP) project is to evaluate the implementation of a structured multimodal analgesic and virtual reality program to decrease opioid exposure and usage while effectively managing postoperative pain. Surgeons prescribe analgesic medications after surgery (Gan, Epstein, Leone-Perkins, Salimi, Iqbal, & Whang, 2018). These medications include IV opioids such as morphine, hydromorphone, and fentanyl.
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