For patients recovering from surgery, discomfort can mean the difference between a traumatic experience and a smooth hospital stay. That's why Patient Voice contest winner Alyssa DeBellis is making their pain her priority.
Most surgical patients nationwide are satisfied with the pain control they're offered during recovery, according to a recent survey by the American Society of Anesthesiologists. Yet 85 percent still report experiencing moderate to extreme pain following their procedures.
This is one of the things motivating students in the David Geffen School of Medicine at UCLA. Pain management after surgery doesn't just lead to better patient satisfaction scores; it leads to healthier patients. "Well-controlled pain is vital in the progression of care plans, length of stay, reduction of postoperative complications and, ultimately, the well-being of our patients," explains DeBellis, a registered nurse in the cardiothoracic surgery unit at Ronald Reagan UCLA Medical Center.
That's why she entered "Putting the Patient's Voice into Actions" a contest sponsored by UCLA's Institute for Innovation in Health. Contest winners receive funding to interview patients and discover better care solutions.
Winner in the "Voice of Pain" category, DeBellis has teamed up with three other nurses to interview patients about pain management after surgery.
Feeling their pain
Pain management isn't a new priority for DeBellis. As the designated "Pain Champion" for her unit, she attends monthly meetings with hospital leaders and delegates from other departments. Together, they review pain policies and procedures and brainstorm solutions for improvement.
"I hate seeing patients in pain," she says. "If I come into a room and the patient appears uncomfortable, I address it quickly. If it was me or my family member, I would want the nurse to do the same."
Now, the nurse and pain champion has put on a new hat: researcher. For the Patient Voice project, DeBellis's team interviewed eight recently discharged cardiothoracic surgery patients, asking how the medical center can improve postoperative pain in patients undergoing similar procedures. "We used a standard set of open-ended questions," she explains, "hoping to identify their understanding of pain management prior to surgery, what interventions best alleviated pain during hospitalization and the best resources available following discharge."
Overall, interview subjects reported being satisfied with postoperative pain levels. Their chief complaints regarded pain medications.
"We've learned the main issues our patients have with pain management [involve] dealing with the side-effects of the medications," she explains. "I did not expect side-effects to be such a big factor, but at times they are preventing patients from utilizing their medications, which can result in more pain. Some participants said these medications also inhibit their ability to retain the information we give them."
Based on these interviews, DeBellis has identified three key areas for improvement:
The team already has a few possible solutions in the works, including "pain boards" — whiteboards in patient rooms that list their pain medications and regimens, and when the next dose is due. "We also plan to utilize Urban Zen to help manage side-effects of pain medications," says DeBellis. "Often, more pills aren't the answer, especially with nausea, and alternative methods are very helpful."
Upon pursuing additional funding, DeBellis also looks to make educational videos for medical staff using footage from her interviews. "It's powerful hearing the same themes over and over directly from the patient," she says. "Participating in this project has given me the opportunity to gain a unique perspective. Bedside nurses don't usually have 45 to 90 uninterrupted minutes to interview patients. It was a very eye-opening and wonderful experience."
By Taylor Mallory Holland