1. 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

2. Objectives Determine if nonpharmacologic therapies reduce pain
Identify cost factors for pain therapies
Assess other benefits of nonpharmacologic therapies

3. 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

4. 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

5. 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

6. Integrative Therapies
Test group offered:
Aromatherapy
Music channel
Comfort hand massage

7. Demographics Age 30-85 Test Group: 30 Control Group: 30
Test group offered integrative therapies 24 hours post operatively

8. 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

9. Integrative Therapy Costs
Aromatherapy per treatment $0.09/each
Music channel $0.00
Lotion use for comfort hand massage $0.66
Empowering to eng

10. 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

11. Medications: Strength and Cost

12. Length of Stay

13. Pain Attenuation

14. 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

15. References
The Joint Commission. (2018). Sentinel event alert: pain management. Retrieved December 8, 2018, from
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 declares-public-health-emergency-address-national-opioid-crisis.html