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Optimizing burn wound procedural pain control, efficiency, and satisfaction through integrated nurse and physician education
Journal article   Peer reviewed

Optimizing burn wound procedural pain control, efficiency, and satisfaction through integrated nurse and physician education

Zachary Fleishhacker, Albert Pedroza, Jia Ern Ong, Nicolas Ronkar, Isaac Weigel, Trinity Janecek, Sarah A Wellsandt, Colette Galet and Lucy Wibbenmeyer
Burns : journal of the International Society for Burn Injuries, Vol.50(3), pp.702-708
04/2024
DOI: 10.1016/j.burns.2023.12.002
PMCID: PMC10999346
PMID: 38114378
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC10999346/pdf/nihms-1952968.pdfView
Open Access

Abstract

Herein, we report the results of a quality improvement project (QI). Following a review of the burn unit practices, a nursing-led, physician supported educational intervention regarding optimal timing, dosage, and indication for medications used during hydrotherapy, including midazolam and opioids, was implemented. We hypothesized that such intervention would support improvement in both nurse and patient satisfaction with pain control management. Patients undergoing hydrotherapy were surveyed. Demographics, opioid dose prescribed (oral morphine equivalents), midazolam use, timing of administration, and adverse events were collected. Patient pain scores (1-10) before and after hydrotherapy and patient and nurse satisfaction scores (1-10) after hydrotherapy were collected. The pre- and post-education populations were compared. P < 0.05 was considered significant. Post-education, administration of opioids (59.1% v. 0%, p < 0.001) and midazolam (59.1% vs. 10.4%; p < 0.001) prior to hydrotherapy significantly improved, leading to fewer patients requiring rescue opioids during hydrotherapy (25% vs. 74%, p < 0.001). Hydrotherapy duration significantly decreased post-education (19 [13.3-30] min vs. 32 [18-43] min, p = 0.003). Nurses' ratings of their patient's pain control (9 [7.3-10] vs. 7.5 [6-9], p = 0.004) and ease of procedure (10 [9,10] vs. 9 [7.8-10], p = 0.037) significantly improved. Patients' pain management satisfaction rating did not change, but the number of subjects rating their pain management as excellent tended to increase (36.4% vs. 20%, p = 0.077). Nursing led, physician supported, education can improve medication administration prior to and during hydrotherapy, increasing the ease of the procedure as well as staff satisfaction.
 Nursing Education Hydrotherapy Pain management Burn injury

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