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Postpartum pain management: improving patient satisfaction
Abstract Number: F-08
Abstract Type: Original Research
Objective: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
scores are standardized, publicly reported results that measure patients’ perceptions of
their hospital experience. This national survey allows for comparisons across hospitals and
also has financial implications as scores are linked to reimbursement. In an effort to improve
patient satisfaction and HCAHPS scores on our obstetric unit, particularly in pain
management, we implemented a multimodal analgesic pathway with intent to maximize
analgesia while minimizing opioid use.
Study Design: Prior to pathway implementation, cesarean patients received patient controlled
epidural anesthesia (PCEA) for 12-18 hrs post-op. Upon stopping PCEA, oral
analgesics were dispensed as needed (PRN) including acetaminophen 650 mg every 4-6
hrs, ibuprofen 600 mg every 6 hrs, and/or oxycodone 5-10 mg every 4-6 hrs. After vaginal
delivery, neuraxial anesthesia was discontinued and the same analgesics PRN were started.
The new pathway included a change in oral medications (dose, timing) for all patients. After
cesarean, 2 hours before discontinuing PCEA, scheduled acetaminophen (1 g every 8 hrs)
and ibuprofen (600 mg every 6 hrs) are administered. Breakthrough pain is treated with
lidoderm patch and/or opioids PRN. Patients with mild/moderate pain are offered
oxycodone 5-10 mg every 4 hrs; those with severe pain are offered hydromorphone 2 mg
every 4 hrs. HCAHPS address pain management with 2 questions: Question 1: How often
was your pain well controlled? Question 2: How often did the hospital staff do everything
they could to help you with your pain?
Results: See Table. Scores for 2015 and 2016, divided into quarters (Q) (cumulatively), are
presented as % of responses in the Top Box, the most positive response category. Top Box
responses increased after the new pathway was implemented in Q1 of 2016, particularly Question 1. Total responses: 214 for 2015; 163 for 2016.
Conclusion: A multimodal analgesic regimen including the combination of scheduled
acetaminophen and ibuprofen and PRN subcutaneous local anesthetics and opioids
appears to improve pain management and overall satisfaction. No other systematic
intervention occurred during this time frame to explain these positive changes. This is a
relatively simple and inexpensive intervention to enhance patient satisfaction and may also
reduce opioid use, which may have important implications.