Abstract
Background Though there is an effective intervention, pain after surgical intervention is undermanaged worldwide. A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. The aim of this research project is to develop a scalable model for managing pain after cesarean section by implementing the World Health Organization's (WHO) pain management guidelines through a combination of implementation research and quality improvement methods. Methods We implemented the World Health Organization (WHO) pain management guidelines using effective implementation strategies. First, we conducted a formative qualitative exploration to identify enablers and obstacles. In addition, we took base-line assessment on pain management implementation process and outcome using a checklist prepared from the guideline and an adapted American Pain Outcome assessment tool version 2010, respectively. Then, we integrated the guidelines into the existing practice by using collaborative iterative learning strategy. We analyzed the data by Statistical Packages for Social Sciences (SPSS) version 21. We compared the before and after data using chi-squared and Fischer's exact test. A change in any measurement was considered as significant at p value 0.05. Result We collected data from 106 mothers before and 110 mothers after intervention implementation. We successfully integrated pain as a fifth vital sign in more than 87% (p value <0.001) of patient, and fidelity was approximately 59% (p value <0.001). In addition, we significantly improved pain outcome measures after the implementation of the intervention. Conclusion and Recommendations. A systematic approach to implement pain management guidelines was successful. We recommend the ward sustain these gains and that hospital, the region, and the nation to replicate the success.
Highlights
Mengistu Hagazi Tequare,1 James John Huntzicker,2 Hagos Gidey Mhretu,3 Yibrah Berhe Zelelew,3 Hiluf Ebuy Abraha,4 Mehari Abrha Tsegay,3 Kesatea Gebrewahd Gebretensaye,3 Daniel Gebre Tesfay,4 Julio Gonzalez Sotomayor,2 Rahel Nardos,2 Mary Beth Yosses,2 Joshua Edwin Cobbs,2 Jennifer Pui Ling Schmidt,2 Wendy Weisman,2 and Leslie K
A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. e aim of this research project is to develop a scalable model for managing pain after cesarean section by implementing the World Health Organization’s (WHO) pain management guidelines through a combination of implementation research and quality improvement methods
We took base-line assessment on pain management implementation process and outcome using a checklist prepared from the guideline and an adapted American Pain Outcome assessment tool version 2010, respectively. en, we integrated the guidelines into the existing practice by using collaborative iterative learning strategy
Summary
Mengistu Hagazi Tequare ,1 James John Huntzicker, Hagos Gidey Mhretu, Yibrah Berhe Zelelew, Hiluf Ebuy Abraha, Mehari Abrha Tsegay, Kesatea Gebrewahd Gebretensaye, Daniel Gebre Tesfay, Julio Gonzalez Sotomayor, Rahel Nardos, Mary Beth Yosses, Joshua Edwin Cobbs, Jennifer Pui Ling Schmidt, Wendy Weisman, and Leslie K. A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. A study conducted in one Ethiopian Tertiary care hospital found more than 91% patients who had a surgical intervention experienced pain [11]. A similar study in another tertiary care hospital of Ethiopia showed 78% of postoperative patients suffering from pain ranging from moderate to severe intensity [12]. Managed postoperative pain may result in the development of chronic postoperative pain, impaired function, and delayed recovery from surgery. It could cause depression, mood alterations, sleep disorders, inability to focus, abnormal appetite, poor hygiene, and prolonged opioid use. Poor postoperative pain management increases the medical costs to the patient and the health system [13,14,15,16]
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