Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study

Abstract

Background: An organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients' requirements.

Methods: Patients from the orthopaedic, gynaecological, visceral, and trauma surgery departments of the university hospital were involved in two prospective surveys. Survey 1 was performed at baseline and survey 2 was performed after the implementation of QMS within an interval of 1 year. The patients were asked to report pain intensity on the visual rating scale, incidence of analgesia-related side-effects, and incidence of pain interference with the items of life quality and their satisfaction with the treatment of POP.

Results: Patients from Survey 2 (n=251) reported 25-30% less pain than those from Survey 1 (n=269) (P<0.0001). Nausea was reported by 40% of the patients from Survey 1 vs 17% from Survey 2, vomiting by 25 vs 11% and fatigue by 76% in Survey 1 vs 30% in Survey 2 (P<0.0001). Life quality and patients' satisfaction improved in Survey 2 vs Survey 1 (P<0.001).

Conclusions: The implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction.

Fig 1

Flow diagram of the study. A pilot pre-test study was performed in 30 patients to test the POP questionnnaire (PPQ) and to generate the data for calculation of the sample size for the study. The first survey was performed in the first half of 2008, where 296 patients received the PPQ on the first postoperative day and on the day of the surgery. The second survey was performed after the implementation of Quality Management Program in treatment of POP in 294 patients. QMS, quality management system.

Fig 2

Scheme of multimodal analgesia adjusted to expected level of postoperative pain used for procedure-specific protocols of POP treatment at the surgical departments of the University Hospital Greifswald.

Fig 3

Prevalence of different pain intensities (weak, moderate, severe) on movement taken on the first postoperative day using VRS 0-10 (VRS-11). Data are given as per cent from total number of patients in the survey; numeric values are absolute number of patients; *P<0.0001; χ²-test.

Fig 4

Frequency of opioid-induced side-effects on the first postoperative day (a) and on the day of discharge (b) given as per cent from total number of patients in the survey; numeric values are absolute number of patients;*P<0.0001; χ²-test.