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UBC Theses and Dissertations

An evaluation of an acute pain service program Pesut, Barbara Kay


The Acute Pain Service (APS), a multi-disciplinary team responsible for acute postoperative pain management, has been a recent development in hospitals. The purpose of this study was to increase our understanding regarding the effectiveness of APSs, to evaluate the impact of the implementation of an APS on pain management within an acute care hospital, and to make recommendations for the improvement of the APS under study. A program evaluative method guided the study design that consisted of three phases. The objective of the first phase was to describe the implementation of the APS. Interviews and a document review provided data that was then analyzed to identify the forces and challenges that shaped three eras in the historical development of the service. The objective of the second phase was to assess the nursing and medical staff satisfaction with the APS through surveys and interviews. Analysis of the data revealed that while the staff was generally satisfied with the program, there were several areas identified for improvement. The objective of the third phase was to assess the impact of the APS on the control of acute pain. A retrospective chart review comparing two groups of abdominal surgery patients using patient-controlled analgesia failed to show any significant difference between acute pain outcomes before and after the implementation of the service. The development of an APS, and its ultimate effectiveness, is dependent upon a number of resources: education, clinical support and adequate communication structures. Control issues surrounding pain management may arise as a result of the implementation of an APS. Immediate recommendations for this program included increasing the visibility of the APS, decreasing the workload associated with the APS modalities, establishing an effective communication network and increasing clinical support to the program. Recommendations for future improvement included strengthening collaboration with the surgeons, promoting more efficient bed utilization by expanding the epidural local anesthesia program and repeating the program evaluation once changes are implemented. Several areas for further research surrounding acute pain outcomes and patient-controlled analgesia were identified.

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