Purpose for the program: Despite the presence of national evidence-based guidelines to direct the management of acute pain, a systematic review of multiple studies shows that only about 50% of patients experiencing moderate to severe pain obtain adequate relief.  Failure to adequately manage pain contributes to multiple physiological and psychological repercussions adversely impacting postoperative recovery.  Complications may include impaired wound healing and mobility, increased risk for deep vein thrombosis, pneumonia,  and pulmonary embolus, increased feelings of anxiety and depression, and eventual development of chronic pain. An analysis of discharge pain scores on a Women’s Surgical Unit (WSU) indicated that only 20% to 40% of patients were meeting their target pain score prior to hospital discharge.  Additionally, approximately 85% of nursing staff indicated that they were dissatisfied with their pain management process and would not recommend this process to other units in the hospital.

Proposed change: Evidence supports the use of comfort-function goals as an effective method of supporting pain management efforts for all patients. A process change involving a focused effort to “target” the patient’s comfort-function goal as a primary component of guiding pain management efforts was designed.  Using a patient-centered approach to guide the process change, several tools, to include a Pain Target sign, were developed to aid the nurse and patient in working together to achieve better pain control.  Additionally, a focused effort was made to initiate IV PCA orders in the Post Anesthesia Care Unit (PACU) prior to discharge to the WSU. 

Implementation, outcomes and evaluation: The WSU embarked on a nine month EBP project beginning with process evaluation and change, staff education, project implementation, and outcome evaluation. The percent of patients not meeting their target pain score by discharge decreased from 32% to 16% over the first month of project implementation.  Additionally, median time to meet the target pain score decreased from 7.5 to 2 hours. 

Implications for nursing practice: Pain control merits a high precedence and affects patient satisfaction with the healthcare experience. The WSU noted that even though patient satisfaction was high, patients were being sent home with uncontrolled pain.  A multi-faceted program involving rapid initiation of IV PCA and a patient-centered approach to pain management using a Pain Target sign had a significant impact on patient outcome.  Future plans include hospital-wide dissemination and implementation of the program. 

Keywords: Postoperative care, pain management, comfort-function goals, evidence-based practice