Date of Award

4-23-2020

Document Type

Dissertation

Copyright Status for Dissertations

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

Abstract

Background

Large joint replacement surgery, including hip and knee arthroplasties, are two of the most common surgical procedures that American adults aged 65 years and older undergo annually. While postoperative pain is expected, if it is not properly managed, it can have deleterious effects on postoperative recovery, including an increased length of stay, increased risk for postoperative complications, and decreased patient satisfaction.

Problem

Postoperative pain is primarily managed pharmacologically, typically with opioid pain medications are administered as needed (i.e., pro re nata [PRN]). Patients request pain-relieving medications when they are experiencing escalating pain, which can be challenging to maintain comfort when medications are administered reactively. Additionally, there is a movement in the orthopedic surgery community to transition to opioid-sparing postoperative care as a result of the opioid-misuse epidemic.

Method

This was a descriptive secondary analysis study using a large data source from the institutional data source (DataCore) extracted for analysis based on the research questions. The sample included more than 4,000 patients who met the criteria of > 65 years of age undergoing joint replacement surgery between September 30, 2015, to September 28, 2018, with more than 36,000 data points in the data set.

Findings

This retrospective study explored temporal patterns of postoperative pain after joint replacement surgery by using extracted electronic health record data, including pain medication administration records and other nursing flowsheet data. The data were analyzed descriptively and displayed using data visualization software. Temporal patterns of pain medication administrations were observed, with four discernable peaks noted at 6 a.m., 9 a.m., 5 p.m., and 9 p.m. Another finding included trends in pain medication administration patterns during weekdays versus weekends. It was also noted that patients who had undergone knee replacement surgeries had a higher average pain score, had more pain medication administrations and longer lengths of stay than those patients who had hip replacement surgeries.

Conclusion

The discovery of these temporal peaks in pain medication administrations may allow nurses and ordering providers to move from a reactive model of postoperative pain management to one that is proactive. Administering pain medications at targeted times, before pain intensity peaks, may act as an adjunct to pain medications, which is increasingly important as practice shifts to opioid-sparing postoperative care pathways.

Related Pillar(s)

Study

Included in

Nursing Commons

Share

COinS