Epworth Collection:http://hdl.handle.net/11434/232024-03-27T23:50:07Z2024-03-27T23:50:07ZSuccessful use of "Choice Architecture" and "Nudge Theory" in a quality improvement initiative of analgesia administration after caesarean section.Slejko, Tiffanyhttp://hdl.handle.net/11434/15252018-10-16T01:22:15Z2018-10-01T00:00:00ZTitle: Successful use of "Choice Architecture" and "Nudge Theory" in a quality improvement initiative of analgesia administration after caesarean section.
Epworth Authors: Slejko, Tiffany
Abstract: BACKGROUND:
Regular, routine, multimodal analgesia provides better pain relief following Caesarean section than reliance on "as required" opiate dosing. This quality improvement report describes the effective use of an education programme coupled with a highlighted, preprinted medication chart, employing "Nudge Theory" principles to achieve significant improvements in the administration of analgesic medications to patients after Caesarean section operations.
PROBLEM:
An acute pain service audit identified a serious deficiency with delivery of regular postoperative analgesic medications to patients following Caesarean section operations.
METHODS:
An audit of pain medication delivery to patients following Caesarean section demonstrated that postoperative analgesia was not being administered in line with local prescribing guidelines. Two interventions were planned: Education sessions for anaesthetic recovery and ward staff. Introduction of a new preprinted and highlighted medication chart. A postintervention audit was then conducted.
RESULTS:
There were statistically significant improvements in all medications administered to patients following the two interventions. For analgesic medications, the rate of administration of drugs in compliance with guidelines rose from 39.6% to 89.9% (P < 0.001 using 2-sample z test). Each subgroup of medications also showed statistically significant improvements in administration compliance.
CONCLUSION:
A combined approach, including application of "Nudge Theory" to the administration of analgesic medication after Caesarean section, considerably improved delivery of medications prescribed for postoperative analgesia.2018-10-01T00:00:00ZSix-year trends in the prescribing and use of multimodal analgesics for postoperative pain at Epworth.Khaw, DamienHutchinson, AnaBotti, Marihttp://hdl.handle.net/11434/14882018-08-15T03:16:13Z2018-06-01T00:00:00ZTitle: Six-year trends in the prescribing and use of multimodal analgesics for postoperative pain at Epworth.
Epworth Authors: Khaw, Damien; Hutchinson, Ana; Botti, Mari
Abstract: Background. The empirical literature and practice guidelines for the management of acute postsurgical pain recommend the administration of analgesics in multimodal combination to facilitate synergistic analgesia, reduce opioid requirements and opioid-induced side-effects. We evaluated the quality of postoperative pharmacological pain management on three orthopaedic wards at Epworth prior to, and following, audit and feedback of prescribing practice.
Methods. In this observational trend study, we observed six-year trends in prescriptions for, and use of, multimodal analgesics following total hip and knee arthroplasty. Cross-sectional surveys of patients’ medication and acute pain outcomes were undertaken at Time 1 (2010,n=86), and after one (Time 2,n=262) and five years (Time 3,n=188). Audit feedback was provided to anaesthetists after Time 1. Surveys were sequential involving patient interviews and medical record audit, with survey days selected purposively to capture all surgeon-anaesthetist dyads.
Results. We found statistically significant, sustained time trends of increased prescribing and use of multimodal analgesics following audit and feedback. Use of analgesics in multimodal combination was associated with modest improvements in rest pain and clinically significant reduction in patient-reported interference of pain with daily activities and sleep. However, ratings of dynamic pain (pain with movement) were high and rescue opioids were under-administered at all time points. Further, while patients reported high levels of medication induced side-effects (eg. nausea, constipation), use of appropriate treatments was low.
Discussion. Findings suggest a sustained change in prescribing of multi-modal analgesics but a need for improvement in prescribing related to common opioid side-effects and a clinical gap in the bedside assessment and management of breakthrough pain and medication side-effects.2018-06-01T00:00:00ZAssociations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study.Ponsford, Jenniehttp://hdl.handle.net/11434/12562017-11-15T10:02:10Z2017-10-01T00:00:00ZTitle: Associations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study.
Epworth Authors: Ponsford, Jennie
Abstract: OBJECTIVES: Compensable injury increases the likelihood of having persistent pain after injury. Three-quarters of patients report chronic pain after traumatic injury, which is disabling for about one-third of patients. It is important to understand why these patients report disabling pain, in order to develop targeted preventative interventions. This study examined the experience of pain and disability, and investigated their sequential interrelationships with, catastrophising, kinesiophobia and self-efficacy 1 year after compensable and non-compensable injury. DESIGN: Observational registry-based cohort study. SETTING: Metropolitan Trauma Service in Melbourne, Victoria, Australia. PARTICIPANTS: Participants were recruited from the Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry. 732 patients were referred to the study, 82 could not be contacted or were ineligible, 217 declined and 433 participated (66.6% response rate). OUTCOME MEASURES: The Brief Pain Inventory, Glasgow Outcome Scale, EuroQol Five Dimensions questionnaire, Pain Catastrophising Scale, Pain Self-Efficacy Questionnaire, Injustice Experience Questionnaire and the Tampa Scale of Kinesiophobia. METHODS: Direct and indirect relationships (via psychological appraisals of pain/injury) between baseline characteristics (compensation, fault and injury characteristics) and pain severity, pain interference, health status and disability were examined with ordinal, linear and logistic regression, and mediation analyses. RESULTS: Injury severity, compensable injury and external fault attribution were consistently associated with moderate-to-severe pain, higher pain interference, poorer health status and moderate-to-severe disability. The association between compensable injury, or external fault attribution, and disability and health outcomes was mediated via pain self-efficacy and perceived injustice. CONCLUSIONS: Given that the associations between compensable injury, pain and disability was attributable to lower self-efficacy and higher perceptions of injustice, interventions targeting the psychological impacts of pain and injury may be especially necessary to improve long-term injury outcomes.2017-10-01T00:00:00ZDeveloping the Epworth HealthCare neuromodulation registry.Pellegrini, MichaelChristelis, NickD'Urso, Paulhttp://hdl.handle.net/11434/11782017-07-31T02:40:37Z2017-06-01T00:00:00ZTitle: Developing the Epworth HealthCare neuromodulation registry.
Epworth Authors: Pellegrini, Michael; Christelis, Nick; D'Urso, Paul
Abstract: INTRODUCTION: Chronic pain is a primary cause of patient-reported disability. Medical management focuses on analgesia, with non-responders often progressing to surgery. However, it was previously reported that 5-50% of chronic pain patients remained symptomatic following spinal surgery. Innovative management strategies such as Spinal Cord Stimulation (SCS) have thus become a focus for pain clinicians. SCS delivers electrical pulses to spinal nerves, modulating transmission of pain signals to the brain. However, SCS is not without complications and a poor response to stimulation, or long-term stimulation failure remain ongoing concerns. To allow improved prediction of trial stimulation outcomes, complication monitoring and the optimizing of long-term stimulation strategies, improved data collection and reporting is required. Clinical registries provide cost-effective means of gaining insights into best practice, therefore this study aims to develop an Epworth HealthCare-wide registry for collecting data on patients undergoing SCS procedures for chronic pain. METHODS: The Delphi technique was utilized to achieve consensus among expert clinicians on the minimum dataset to be captured that best reflected current clinical practice. This dataset was transferred to forms for both clinicians and participants to complete. Online forms and a database were developed via the web-based software 'WebQi'. RESULTS: The minimum dataset included standardized pain, function and quality-of-life measures to be collected pre- and post-procedurally. Broad agreement was reached among a group of ten clinicians, and the forms have been distributed. The registry is undergoing final modifications and revisions prior to final implementation. CONCLUSIONS: This study is the first of its kind in Australia. It has the potential to set a benchmark for system-wide approaches to data collection in SCS surgery and will facilitate reporting to the wider literature. It will promote interdisciplinary collaboration and has the potential to unify clinicians in continuous care improvement in a rapidly evolving, technology-driven setting.2017-06-01T00:00:00Z