Effectiveness of an Electronic Pain Notification System on Postoperative Pain

Abstract

Background: Pain management is an important responsibility of the entire health care team. A 2008 nursing documentation audit at the study hospital showed inadequate pain assessment. In response, an Electronic Notification System (ENS) for Registered Nurses (RNs) was implemented in one surgical unit of the study hospital in 2008-2009. Purpose: The purpose of this study was to determine the effectiveness of the ENS on postoperative pain measurements, pain intensity, and total narcotic analgesic use. Furthermore, the association between pain control and patient outcomes such as physical therapy participation, length of hospitalization, and discharge disposition was examined. Methods: A retrospective, descriptive-correlational design used medical record data to compare postoperative pain and related outcomes before and during the ENS implementation. Hospitalized inpatients undergoing hip or knee joint replacement, laminectomy, or spinal fusion were studied. The pre-ENS group included 95patients, whereas the ENS group had 113 patients. Linear mixed modeling was used to account for the repeated pain observations clustered within patients, while controlling for potential covariates. Results: There were no significant differences in frequency of pain measurement nor in pain intensity between the pre-ENS and ENS time periods. However, other important covariates were found to significantly influence pain intensity including history of mental illness (t=2.028, p=.045), pre-operative opioids (t=3.307, p<.001), and age (t= -3.383. p<.001). Only age (t=3.406, p<.001) and pain level on day 2 (t=2.306, p= .025) were significant predictors of length of stay. Conclusion: While the use of an electronic notification system reflects a widely used technology, the effectiveness was not demonstrated in this population and setting. The findings showing that patients with a history of mental illness and opioid use report higher pain intensity, confirm the findings of previous studies and should be incorporated in developing customized pain management plans. Innovative new devices such as ENS could be a valuable tool to assist nurses in pain assessment and documentation but current evidence does not support their use.