Congress Abstracts 2003

47

IMPROVING PAIN MANAGEMENT FOR THE POSTOPERATIVE THORACIC SURGERY ONCOLOGY PATIENT UTILIZING EPIDURAL INFUSIONS. Louisa Kan, RN, BSN, OCN^®, Janet Taubert, RN, MSN, OCN^®, and Tai Ly, RN, MSN, CS, CCRN, M.D. Anderson Cancer Center, Houston, TX.

An epidural infusion creates a localized band of analgesia at the site of incision without sedation, which is especially useful in thoracic surgery to overcome the splinting induced by pain. Patients are able to cooperate with respiratory therapy, mobilize secretions, and begin early ambulation. In the patient’s satisfaction review in our inpatient thoracic surgery unit, 75% of the patients were satisfied with their epidural infusion pain control. Others experienced either pain during their pulmonary exercise and mobility or undesirable epidural narcotic complications. Pneumonia, or atelectasis, was complicated with the reluctant pulmonary exercise and mobility. Epidural narcotic complications, staff’s inexperience in epidural administration, and patient’s insufficient knowledge in epidural pain relief and use of the infusion pump were major causes of ineffective pain control. The goal of this project is to improve patient’s pain management and decrease pulmonary complications. The PDCA (Plan, Do, Check, Act) quality improvement process is applied to identify the key elements of patient education, implement guidelines for epidural use for post-operative pain management into our nursing pain assessment and management standards, and to enhance effective communication amongst the staff and pharmacy. A postoperative pain service (PPS) committee was formed, consisting of an anesthesiologist, nurse practitioner, clinical nurse specialist, instructor, pharmacist, and clinical staff from thoracic in-patient unit and outpatient clinic to develop a patient teaching pathway, which provides a continuum of education. The committee also created a new pain assessment and documentation form for epidural infusions; the next step is to formulate in-services for educating staff. A new delivery schedule and paging system has been developed to directly page the corresponding pharmacist to reduce the waiting time for the epidural infusion bag. Our expected outcome is that the patient satisfaction rate with pain control will increase from 75% to 90% and there will be a decrease in the incidence of pulmonary complications. This remains a work in progress.