Improving PACU Pain Management

There is always room for improvement in pain management for all patients throughout the world. It was Dr. Dorette Husbands, a final year anesthesia resident at the Georgetown Public Hospital Corporation, who approached us for help with her Master’s Thesis. She noticed that the nurses in the post anesthesia recovery room did not have a pain assessment tool, and that large doses of opioids were given to patients intravenously without knowing if the pain was severe or not. Other patients appeared to be undertreated. She proposed a quality assurance project to improve the quality of care for acute pain management in recovery room patients.

This is where we got involved helping to collect data. After quietly observing nurses care for 30 patients, today we began our intervention and introduced a combined visual analogue scale and Baker-Wong faces scale, along with an intense education session, teaching nurses to titrate opioids, and use multimodal therapy. Below nurses are taking a pretest to evaluate pain knowledge and barriers against treatment.

After the course, the nurses enthusiastically sprang into action and one nurse told me that instead of giving 7.5 mg of IV morphine to a patient, she used the pain assessment tool and gave 2.5 mg instead. The patient’s pain was relieved and he was not overly somnolent. He was discharged from PACU one half hour later.

Now for the next step. Tomorrow and Wednesday pain talks will be given to the entire anesthesia department, and hopefully this will lead to the creation of PACU standing orders for pain. Of course it is one step at a time. We are hoping the next set of volunteers will become involved in data collection post-intervention, and continue with pain education throughout the hospital.