Summary
Improving postoperative pain care; an Acute Pain Service data analysis
Rianne van Boekel
AIM: Inadequate postoperative pain management is associated with several negative consequences, patient discomfort, and is linked to increased healthcare costs. This thesis explores the quality of postoperative pain management in hospitals.
METHOD: Several studies and designs were applied. The thesis is organized in three main parts based on the three factors of Donabedian’s framework for modelling the quality of care: structure, process and outcome.
FINDINGS/CONCLUSION: Postoperative pain management can be improved by 1) optimizing Acute Pain Service (APS) teams, 2) performing frequent multidimensional pain assessments, and by 3) evaluating outcome measures including postoperative complications. Using the Donabedian model, we have shown that the structure, the process, as well as the outcome of postoperative pain management are interrelated factors. In order to improve postoperative pain management, all the influencing factors need to be addressed. Therefore, a hospital-wide improvement program is necessary which reviews the role of APS teams and other professionals, and focuses on the improvement of adherence to multidimensional pain assessment and the evaluation of pain treatment. The program evaluation should include: measures of the intensity of the pain, the patient’s opinion on the acceptability of the pain, the observation of physical function, and the development of complications after surgery.
Keywords: Postoperative pain, postoperative complications, pain measurement, pain management, quality of health care