Pain Attenuation with Integrative Therapy in Post Mastectomy Patients Sharp Memorial Hospital, Short Stay Observation Unit: Homa Shahabzadah, RN, MSN Student; Elizabeth Isaacs, BSN, RN, Advanced Clinician; Susan Moore, MSN, RN, CNS
Objectives Determine if nonpharmacologic therapies reduce pain Identify cost factors for pain therapies Assess other benefits of nonpharmacologic therapies
Project Details 452 bed hospital in southern California Investigators: MSN student, advanced clinician, and clinical nurse specialist Project origination: Interprofessional Clinical Practice Council Promoted integrative therapy use with conventional care Study applied integrative therapy use for pain attenuation
Background Mastectomy patients Experience pain Have social and psychological concerns Require physical rehabilitation Opioid epidemic recognition in the USA Patients might refuse opioids leading to: Limitations in physical rehabilitation Symptoms of depression
Project Foundation The Joint Commission – January 2018 Hospitals must offer nonpharmacological pain therapies Recognition of integrative modalities use in hospitals Commission January 2018 that hospitals must offer nonpharmacologic pain therapies in the course of treatment for patients having pain. This led to the recognition of integrative modalities such as aromatherapy, energy treatments, light touch, and auditory therapies such as music as being nonpharmacologic therapies which could be used in the hospital. Integrative Modalities Medications
Integrative Therapies Test group offered: Aromatherapy Music channel Comfort hand massage
Demographics Age 30-85 Test Group: 30 Control Group: 30 Test group offered integrative therapies 24 hours post operatively
Medication Costs Category Test Group Control Group Average cost of meds per administration $1.32 $2.27 Total cost of meds $223.67 $515.22
Integrative Therapy Costs Aromatherapy per treatment $0.09/each Music channel $0.00 Lotion use for comfort hand massage $0.66 Empowering to eng
Empowers patients to engage in self-care Unexpected Outcomes Decrease in: Medication costs Strength of pain medications administered Length of stay Empowers patients to engage in self-care
Medications: Strength and Cost
Length of Stay
Pain Attenuation
Key Points for Integrative Therapy Use Category Test Group (30 patients) Control Group Average length of stay (hours) 33.3 37.6 Total length of stay (hours) 998.7 1129.2 Average cost of medication $1.32 $2.27 Total cost of medication $223.67 $515.22 Average strength of opioids administered (mme) 12.3 18.6 Total strength of opioids consumed (mme) 2083.1 4225.7 Average RN visits to patients room for opioid administration 5.6 7.4 Total RN visits to patients room for opioid administration 169 223 Average level of pain at admit (scale 0-10) 3.8 3.2 Average level of pain at discharge (scale 0-10) 2.2 2.6 Average pain at start of pain treatment 3.7 5.4 Average pain after treatment 1.4 Average pain 4 hours later 0.6 2.7 Decrease in: Length of stay Medication costs Opioids received Strength of opioids administered Average RN administration frequency of opioids Pain level after four hours MME: Morphine Milligram Equivalence
References The Joint Commission. (2018). Sentinel event alert: pain management. Retrieved December 8, 2018, from https://www.jointcommission.org/topics/pain_management.aspx U.S. Department of Health and Human Services. (2018, May 23). HHS acting secretary declares public health emergency to address national opioid crisis. Retrieved December 8, 2018, from https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary- declares-public-health-emergency-address-national-opioid-crisis.html