Evidence-based Practice Changes Improve Pain Management After Orthopaedic Surgery
Many orthopaedic surgery patients receive a single-shot peripheral nerve block (sPNB) — a one-time local anesthetic injection — to reduce post-operative pain. As the anesthetic wears off, approximately 30 percent of patients experience rebound pain.
To reduce rebound pain, the Braunwald Tower 12BC unit-based practice council, led by co-chairs Katie Bradley, BSN, RN, and Lisa Hulme, MSN, RN, worked with MaryKate Hegarty, MSN, RN, former nursing director, Michael Weaver, chief of Orthopaedic Trauma, Jose Zeballos, MD, chief of the Post Operative Pain Service (POPS) and Inna Zinger, DNP, MSN, ANP-BC, of the POPS.
They developed a multi-faceted plan, which included:
- Creating a smart phrase in EPIC to capture a patient’s pain level upon admission and every six hours until an sPNB wears off.
- Assessing the sPNB more frequently and paging the POPS if a patient’s pain increases
- Conducting a literature review for evidence-based practices
- Collaborating with the Orthopaedic Service and POPS to implement bedside interprofessional rounds in the evenings
- Working with the interprofessional team to develop a customizable order set to ensure patients were premedicated prior to their sPNB wearing off
- Educating nurses on the unit about the changes, with support from Melissa Moniz, MSN, RN, professional development manager
The evidence-based changes nurses and team members made in alignment with the professional practice model helped to decrease pain for patients who received a sPNB.
Specifically, following the implementation of evening interprofessional rounds, the percentage of these patients with an average functional pain score under 4 improved to 80 percent in August 2021.
Why it’s Magnet: Magnet designation requires two examples of an improved outcome associated with an evidence-based change made by clinical nurses in alignment with the Professional Practice Model as part of the Exemplary Professional Practice component (EP1EOa) of the Magnet model. This is one of many examples of nurses practicing in alignment with the components of the PPM: collaboration, compassion, knowledge and excellence in support of relationship-based care.. It’s who we are.
Additional members of the unit-based practice council who participated in these efforts include: Lisa Gillis, MSN, RN, Paula Criscuolo, BSN, RN, Julie Archibald, MSN, RN, Allison Daley, MSN, RN, Lian Atturio, BSN, RN, and Alex Machajewski, MSN, RN, CNL, current nursing director.