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New technology, stronger medications, and aggressive pain management services are worth nothing in the control of postoperative pain if the patient doesn’t follow instructions for at-home pain control.
"There are two main reasons our patients don’t take pain medication as directed," says W. Gray McCall, CRNA, MHDI, MSN, anesthesia program coordinator at Trover Foundation at Murray State University in Madisonville, KY. "Older patients fear addiction to pain medication, and males don’t want to appear weak and unable to handle pain," he explains.
Because patients are wary of taking more pain medication than needed, they often wait until the pain is too severe to control with oral medication, says McCall. Education is key to patient compliance, but pain control teaching may not be occurring at the best time for the patient, McCall adds. "Specific pain control education should begin in the physician’s office when the patient is first discussing surgery." The patient is not as anxious at this time and will have time before surgery to absorb the information and ask questions, he says.
"On the morning of surgery, the patient is apprehensive, cold, and usually drowsy from sedation," says McCall. Any teaching done at this time will not be recalled, he says. Post-op teaching with family members present might not be any more effective, he says. "The patient is still feeling the effects of anesthesia, and family members are concentrating on their primary focus of getting the patient home."
Family members also are wary of overdosing the patient, so if instructions say the medication can be given every four to six hours, they generally wait six hours, he says. The extra two hours might be the difference between moderate pain that can be controlled and severe pain that cannot be alleviated by the medication, he adds.
Brochures that spell out directions to take pain medication before pain is severe and instructions to call the physician if the medication doesn’t alleviate the pain are helpful if given to patients at the time surgery is scheduled by the surgeon’s office, says McCall. "Make sure your brochures or handouts are written in simple-to-understand language and use large print to make them easier to read."
The Internet has proven to be a good way to educate patients on pain control for Beth Israel Deaconess Medical Center in Boston, says Denise Goldsmith, RN, MS, MPH, program manager of nursing informatics.
Although Beth Israel has had a Web site (www.bidmc.harvard.edu/ambsurg) with information for same-day surgery patients since 1997, the pain management section was developed in the past year as a result of a nurse’s research that showed patients did not recall receiving pain control instructions or could not recall the details of the instructions, says Goldsmith. (For more information on Beth Israel’s same-day surgery Web site, see Same-Day Surgery, April 2000.)
"Before we put time into developing the pain management section, we first surveyed patients to see if the majority had access to the Internet, Goldsmith says. "After discovering that 52% did have access, we developed the pain management section."
Because staff wanted to see if the Web site’s pain control information would affect outcome, they didn’t make the site available to everyone at first. "We set up a control group and a study group, with the study group having the password to access the pain management section," explains Goldsmith. The control group could access other parts of the Web site that included general pre-op information and directions to the facility, she adds.
Study results show that 85% of patients in both groups accessed the Web site, with no difference between the groups in frequency of access, she adds. A questionnaire was sent home with the 195 patients that comprised both groups on which they rated their pain upon arriving home, on the night of surgery, and on the day following the surgery. Results showed that patients with access to the Web-based pain control information reported significantly lower pain than patients in the control group.
While less than 10% of the group with access to pain information reported discomforting levels of pain upon arriving home, almost 25% of the control group reported discomforting levels of pain. The percentage of patients reporting discomforting pain remained almost 15% higher for the control group on the night of surgery and the day after surgery. More control group patients also reported distressing, horrible, or excruciating pain than patients with access to pain information, says Goldsmith.
The pain control site is now open to all patients, says Goldsmith. "We let patients know about the Web site through brochures that are available in physicians’ offices, during the preoperative telephone call, and in our family waiting room." The family waiting room has a personal computer that displays the Web site so family members without access to the Internet at home can get information while they wait, she adds.
For more information on patient education regarding pain control, contact:
• W. Gray McCall, CRNA, MHDI, MSN, Anesthesia Program Coordinator, Trover Foundation, Murray State University, 435 N. Kentucky Ave., Suite A, Madisonville, KY 42431. Telephone: (270) 824-3460. E-mail: firstname.lastname@example.org.
• Denise M. Goldsmith, RN, MS, MPH, Program Manager of Nursing Informatics, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02115. E-mail: email@example.com.
Suggestions on how to educate patients about pain control following surgery can be found on these Web sites:
• www.aspan.org. This site is sponsored by the American Society of PeriAnesthesia Nurses in Cherry Hill, NJ. Patient information included on the site covers pain management as well as orientation to what happens during different times of the surgical experience.
• www.pain.com. Sponsored by the Dannemiller Memorial Educational Foundation in San Antonio, this site provide free, comprehensive information on pain management for health care professionals and patients. A section devoted to perioperative pain was launched in August 2000.