Document Type

Report

Publication Date

Spring 2023

Date of Final Presentation

4-30-2023

Committee Chair

Sara Ahten, DNP, RN NC-BC

Committee Member

Mary Renee Walters, PhD

Coordinator/ Chair of DNP Program

Teresa Serratt, PhD, RN

Abstract/ Executive Summary

Problem Description

The opioid epidemic has been ravishing communities in the United States for nearly two decades, resulting in opioid misuse, dependence, and overdose-related deaths. Healthcare providers have inadvertently fueled the epidemic by overprescribing opioid medications contributing to 40% of the opioid overdose-related deaths. One in every 48 patients who receives an opioid medication for the first time will become a chronic user of these medications. Furthermore, 6% of all surgical patients will continue chronic use of opioid medications 90 days after their surgeries regardless of absence of pain. With over 50 million surgical cases performed each year in the United States, the number of surgical patients adds another 2 million potential chronic users of opioid medications. Educating surgical patients about pain management choices better prepares them for shared decision making.

Setting

The setting of this project is a major trauma medical center in the Pacific Northwest. The medical center’s perioperative clinicians continue to largely treat pain with opioid medications, especially in the post anesthesia care unit (PACU).

Rationale

Bandura’s self-efficacy theory provides the rationale for using patient-education as a tool in this project. The strength of people’s convictions in their own effectiveness will determine the level of coping with a given situation. Recognizing that pain is a temporary part of surgery that will subside, enables surgical patients to become self-sufficient in diverting their thoughts from sensing pain while focusing on other activities. This consequently helps them cope better with surgical pain. This leads to reduction in opioid consumption after surgery and improved outcomes.

Specific Aims

The project aimed to inform patients of opioid dangers, provide expectations of surgical pain, and describe alternative non-opioid therapies for pain management. There are many methods to convey the information, however, given the wide range of healthcare literacy between patients, audio, and visual aids -specifically cartoon animations- have been proven to enhance learning and engagement. The project focused on developing an animated educational video to enhance awareness of opioid dangers.

Project Outcomes

A six-minute-high quality educational video animation was developed by the project manager along with data collection, and post intervention assessment tools. All stakeholders were informed of the aims of the project and understood the intervention-related processes prior to implementation with every patient. Receiving and accessing the video animation were paramount to the success of the project. Thus, two outcomes for the project ensured focus on patients’ receiving and accessing the video animation. Outcomes related to level of anxiety and pain after watching the video animation allowed for assessment of the intervention’s potential influence on patients’ perception of both. Patients were further assessed in achieving three or more of five desired post-surgical outcomes that are known to be highly influenced by pain and opioid consumption. Stakeholders feedback on potential improvements to the project were sought after implementation.

Implementation and Evaluation Plan

12 patients were individually invited for participation between June 2022 and August 2022. The video was shown to every patient prior to surgery by the project manager, ensuring access of all participants. Intervention’s influence on patients’ anxiety related to surgical-pain management was assessed by direct questioning of patients during hospitalization. Electronic health records were also reviewed for reports of anxiety, pain scores, and achieving three or more of the following outcomes: 1. Ambulated early (on day of surgery or the next morning), 2. Lacked complaints of nausea and vomiting, 3. Tolerated self-care activities. 4. Reported minimal or no drowsiness, and 5. Reported readiness for discharge to home. Aggregate data was tabulated, and descriptive statistics were used to quantify results in numbers and percentages.

Results and Interpretation

The initial aim was to assess the effectiveness of the educational tool exclusively on bariatric surgery patients. However, the departure of the project’s bariatric surgery champion at the host institution greatly minimized the ability to enroll bariatric surgery patients in the project. Consequently, the surgical patient pool had to be broadened to allow for sufficient number of enrollees. Other types of surgeries were chosen based on their potential to produce relatively similar pain burden postoperatively as bariatric surgeries. Of the 12 patients who participated in the project, five (41.5%) were female, five (41.5%) were male, and 2 (17 %) self-identified as transgender. Eleven patients (92%) did not require an anxiolytic before surgery and after viewing the video and the opportunity to ask follow-up questions. The presence of the project manager during viewing of video allowed patients and their families to have immediate access to further clarifications and answers to questions. Ten patients (83%) did not receive opioid medications during surgery and five (42 %) did not require any pain medications after surgery. 59% of patients found the intervention educational and helpful. 67% of patients reported their pain as mild after surgery.

Conclusion

Patient-focused education prior to surgery regarding surgical pain management could be a helpful tool in alleviating anxiety and reducing opioid consumption after surgery, especially using a multimedia tool such as video animation.

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