Management of acute postoperative pain in Australian hospitals - room for improvement

Objective: To describe a quality improvement initiative in the management of acute postoperative pain in Australian hospitals. Design: Multicentre, cross-sectional, retrospective inpatient medical record review and post-discharge surveys of patients and their General Practitioners (GPs), conducted between October 2006 and October 2007, before and after targeted educational intervention. Setting: 62 Australian hospitals - representing the spectrum of regional/remote to principal referral and including private and specialist hospitals. Participants: Up to 50 adults undergoing emergency/elective surgery per hospital, in each of baseline and follow-up phases. Outcome measures: Documented preoperative education; pain and sedation assessment; safe and effective analgesic prescribing and communication of a pain management plan to patients/carers and their GPs at discharge. Results: 2704 baseline (2780 follow-up) patients were included. Documentation of preoperative education regarding postoperative pain was noted for 31% (44%) of patients. 57% (76%) of patients had at least one pain score documented in the postoperative data collection period. Of patients prescribed analgesia, 68% (74%) were prescribed regular paracetamol and 23% (18%) only as needed analgesia. Of patients prescribed opioids, 50% (61%) had at least one documented sedation score and 87% (90%) were prescribed an antiemetic agent. Discharge pain management plans were documented for 26% (40%) of patients and of these, 86% (87%) were communicated to patients and 71% (77%) to GPs. Conclusions: Targeted interventions including one-on-one educational visiting and feedback of comparative data improved some key outcome measures; performance and documentation of preoperative education, post-operative pain and adverse event assessment and discharge communication with patients and GPs.