The University of Texas M. D. Anderson GI Surgery Nurses Develop Education Program to Improve Satisfaction With Patient-Controlled Analgesia

HOUSTON—Patient satisfaction with patient-controlled analgesia (PCA) rose from 75% to 90% with an education program implemented by Elizabeth Fogarty, RN, and colleagues from the gastrointestinal surgery unit at The University of Texas M. D. Anderson Cancer Center. The patient and staff education program is now being used in nursing practice throughout the entire institution.

The project objectives were to improve patient satisfaction with PCA and to improve pain control in the hope that it would decrease idleness and pulmonary complications by increasing mobility and improving inhalation ability. "We traced the steps of the patient through the clinic, pre-op clinic, post anesthesia care unit, surgical intensive care unit, and gastrointestinal inpatient unit and added representatives from each of those areas to our team," Mrs. Fogarty reported. "We also added an anesthesiologist, nursing instructor, patient educator, and quality-improvement representative for advice and guidance."

The teams’ brainstorming produced a cause and effect "fishbone diagram" which revealed educational deficits among patients and staff. The researchers surveyed 30 patients for baseline knowledge. "Looking two cycles back in the quality improvement process, we determined that education of patients on PCA pumps needs to start in the clinic," Mrs. Fogarty said.

Consistency Emphasized

A staff survey revealed that there was an unmet need for a standard approach to teaching and managing patients on PCA pumps. The team developed a PCA Guideline Sheet and on-line educational materials. The guidelines were incorporated into the unit’s standards for nursing pain assessment and management and were included in a lesson plan for educating staff. Staff education emphasized consistency in all areas of patient care, from pre-op clinic to patient discharge after surgery.

The guidelines include assessment, intervention, reassessment, and side effects.

• Assessment includes use of a numeric pain scale to measure pain at rest, pain with activity, and level of pain acceptable to the patient. Assessment also takes into account the patient’s ability to cough and to breathe deeply, pain site, pain characteristics such as duration and frequency, and pump details such as whether the PCA control button can be easily reached by the patient.

• Intervention includes education of patient and family about pain management in general and about use of the pump in particular. This incorporates "reassurance to the patient that use of the prn medication schedule will not cause the patient to get too much medication or to become an addict," Mrs. Fogarty said.

• Reassessment is done by administering the pain survey again after the educational component.

• Side effects evaluated include nausea, pruritis, drowsiness, constipation, and paresthesia.

"After patient education materials were used and the staff was educated, we resurveyed the patients for improvement. Patient satisfaction with pain control increased from 75% to 90%. Because of the high success rate, we chose to incorporate these methods and guidelines into nursing practice within our entire institution," Mrs. Fogarty reported.