///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Postpartum pain management: improving patient satisfaction

Abstract Number: F-08
Abstract Type: Original Research

Jamie D Murphy MD1 ; Christopher L. Wu MD2; Linda M Szymanski MD, PhD3; HeeWon Lee MD4

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.

SOAP 2017