| Summary: | The purpose of this study was to evaluate selected outcomes of the Frail Elder Pain
Management Program (FEPMP) related to postoperative pain management following hip fracture
repair at a community hospital. The FEPMP was based on standards of geriatric and pain
management practice and consisted of education sessions for nurses and surgeons, pre-printed
analgesic order forms, a pain management flow sheet, written resources, and clinical support.
Application of the Logic Model as the conceptual framework to the FEPMP demonstrated the
conceptual integrity of the program.
The hypotheses for the study focussed on measuring changes that occurred in:
1) surgeon's analgesic ordering practices, 2) nursing assessment related to pain, 3) nursing pain
management practices. Research questions were related to 1) behaviours related to pain and
delirium and overall pain control 2) the adverse effects of analgesia and 3) the use of
psychoactive medications to control behaviours that may be related to pain.
The charts of 147 patients age 75 and older who had hip fracture repairs were randomly
selected and audited from two baseline periods and one period two years after the program was
implemented. There were 47 charts in baseline one, (1992-93) 50 charts in baseline two (1994-
95), and 50 in the post-program period (1997-98).
There were 124 women and 23 men in the sample with an average age of 83 years. Sixty
to 70 percent of the patients had a cognitive impairment and most had at least two chronic
conditions. Patients in all three time periods were similar with respect to age, gender, cognitive
status and number of pre-existing diseases. The post-program group patients were more likely to
have pre-existing pain and a spinal anaesthetic postoperatively.
Pain management was more consistent with the standards of practice and patient
outcomes improved post-program compared to the baseline periods. The surgeons' prescription
practices improved significantly as did the overall pain management practices of nurses. Pain
assessment practice showed a modest improvement but this was not statistically significant.
Behaviours indicative of delirium and pain were less common in the post-program group. The
frequency of restlessness was significantly lower. Agitation, confusion and resistance to care
were lower as well although these changes were not statistically significant. Despite more
frequent analgesic dosing in the post program group, there was no increase in adverse effects of
analgesia. Patient assessments for the first 48 hours postoperatively were reviewed and patients'
pain control was described as either good, adequate, poor or unable to be determined. Patients in
the post program group were significantly more likely to have good to adequate pain control than
the baseline periods where the level of pain control was usually either poor or unable to be
determined.
The findings of the study were discussed in relation to the literature and methodological
concerns inherent in the design were addressed. Implications for nursing practice, administration,
and education were described and recommendations for future research were identified.
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