A Biopsychosocial Approach to Pain Management.

INTRODUCTION: The goal of this project was to implement a biopsychosocial approach to pain management and measure the effects on patient perception of pain. It was hypothesized that the intervention would positively impact patients' perception of pain. METHODS: A validated survey, the Revised American Pain Society Patient Outcome Questionnaire, was administered to patients on the day of discharge from Avera McKennan Hospital Orthopedics Unit 2-East and 2-West following total joint replacement. Prior to data collection, 2-East was renovated to create more welcoming and comfortable patient rooms. Pre-intervention data was gathered April through June of 2017. In July, a four-hour staff training session on alternative comfort measures and pain medication administration took place. Post-intervention data was gathered July through September of 2017. Data was analyzed via Microsoft Office Excel using t-test and chi-square analyses. RESULTS: Statistically significant improvement was seen on 2-East in pain severity and relief, least amount of pain reported, use of non-medicine methods, and impact of pain on sleep, activities, and negative emotions. Analysis of 2-East and 2-West combined revealed a decrease in overall pain, medication side effects, and impact of pain on sleep, activity, and negative emotions, although not statistically significant. In addition, there was an increase in helpfulness of information, ability to participate in decisions about pain management, and use of nonpharmacologic strategies, although not statistically significant. CONCLUSIONS: The study found outcomes consistent with the hypothesis, although not all results were statistically significant. The complementary use of nonpharmacologic interventions shows promise for improving patient experiences post-surgery. However, more research would be necessary to recommend the widespread implementation of these techniques.

Creating a Culture of Mobility: Using Real-Time Assessment to Drive Outcomes.

BACKGROUND: Recent studies have demonstrated the safety and feasibility of early mobilization of patients in the hospital setting. Promoting early mobility improves patients' ability to perform daily activities and attend to basic needs. It also preserves patients' dignity and independence. We implemented a culture of mobility program to promote awareness of the importance of early mobility among health care providers, patients, and family caregivers on an inpatient orthopedic unit. PURPOSE: The goal of the program was to empower clinical RNs, physical therapists (PTs), and occupational therapists to conduct dynamic, ongoing assessment of a patient's functional status so the plan of care could be modified in real time to promote functional independence and prevent immobility-associated complications. METHODS: Nursing and therapy professionals used three mobility assessments to estimate the degree and type of activities a patient could safely perform during a hospital stay: the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, the Physical Therapy Mobility Assessment (PTMA) scale, and the Occupational Therapy Assistance Assessment (OTAA) scale. The three assessment tools were incorporated into the electronic health record. To evaluate their performance, we retrospectively collected patient data before (baseline) and after (intervention) their implementation. There were 61 patients in the baseline group and 59 in the intervention group. RESULTS: The clinical characteristics of patients in the two groups were comparable, including demographics, diagnoses, and activity orders. The JH-HLM and PTMA scores correlated significantly with the maximum distance patients ambulated as measured independently by RNs and PTs, suggesting the tools worked as expected to estimate the actual activity patients performed. Importantly, we found that the intervention improved patient mobility, as evidenced by significant increases in the maximum distances and the number of times patients ambulated. Further, the initial scores on the JH-HLM, PTMA, and OTAA scales correlated significantly with the length of stay (LOS), an important outcome variable. This suggests that the mobility assessments can also be used to predict LOS and thus optimize hospital bed management. CONCLUSIONS: Nursing and therapy professionals successfully implemented three new mobility assessment tools on an inpatient orthopedic unit. The tools captured real-time information about patients' functional ability that was used to encourage patients' mobility.