Date of Award
Doctor of Nursing (ND)
Elizabeth Portugal, MSN, APRN, NMW
Multimodal pain management has been recognized as the most effective modality and the gold standard for pain management for more than a decade. However, these protocols remain poorly utilized and are applied inconsistently. This has led to inferior pain management, poor outcomes, and an increased risk of opioid dependence or addiction. In this project, I sought to address the utilization of multimodal pain management in an inpatient surgical service. A ten-day review of patient care revealed that pain management provided to patients on our service was inadequate and might be improved by adopting and implementing more consistent and systematic protocols for drug administration. This change might lead to fewer unscheduled (i.e., pro re nata [PRN]) drug doses, reduced narcotic use, more rapid recovery, and improved patient outcomes.
I began by reviewing the cases of 29 patients who had received routine pain management on our service. Of these, 17 patient cases were comparable to another 21 patients who had undergone treatment during the implementation of multimodal pain management. I compared the average number of PRN IV/narcotic doses used by patients in each of these two groups each day (i.e., 24 hrs) during their hospital stays.
The results of my analysis revealed that the 17 patients in the control group used an average of 2.1 doses of PRN IV/narcotic medications per day throughout the length of their hospital stays. By contrast, the 21 patients who were treated with the multimodal pain management strategy required only an average of 1.43 doses of PRN IV/narcotic medications per day. This difference represents a 32% decrease in PRN IV/narcotic use while in the hospital. The patients treated with the multimodal pain management strategy also required fewer prescriptions for narcotic medications at the time of hospital discharge.
My findings suggest that a consistent protocol for multimodal pain management would likely benefit a large population of patients requiring hospital care. Future discussions with the hospital administration may lead to the implementation of a pain-management protocol designed to build on the patient-care benefits identified here.
Garcia, Erik A., "Multimodal Pain Management for Surgical Inpatients" (2023). Cohort XI. 4.