Pain Attenuation with Integrative Therapy in Post Mastectomy

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 1. Determine if nonpharmacologic therapies reduce pain 2. Identify cost factors for pain therapies 3. 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 Study integrative therapy use with conventional care applied integrative therapy use for pain attenuation

Background Mastectomy patients Experience Have social and psychological concerns Require Opioid pain physical rehabilitation 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 Medications Integrative Modalities

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

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

Medication Costs Category Average cost of meds per administration Total cost of meds Test Group $1. 32 $223. 67 Control Group $2. 27 $515. 22

Integrative Therapy Costs Aromatherapy per treatment $0. 09/each Music channel $0. 00 Lotion use for comfort hand massage $0. 66

Unexpected Outcomes Decrease in: Medication Strength Length costs of pain medications administered of stay Empowers patients to engage in selfcare

Medications: Strength and Cost Other Comparison Factors $18. 62 Avg. Strength of Opioids consumed $12. 25 $2. 27 Avg. Cost of Meds $1. 32 $37. 64 Avg. Length of Stay (hours) $33. 29 0. 0 5. 0 10. 0 15. 0 Control Group 20. 0 Test Group 25. 0 30. 0 35. 0 40. 0

Length of Stay Average Length of Stay 25 21 9 5 0 hr - 48 hr Test Group 48. 1 HR - 72 HR Control Group

Pain Attenuation Control Versus Test Group Pain Level Attenuation 5. 4 3. 7 2. 7 1. 4 0. 6 Avg. Pain at start of Pain Treatment Modality Avg. Pain after treatment modality Test Group Control Group Avg. Pain 4 hours later

Key Points for Integrative Therapy Use Category Average length of stay (hours) Test Group (30 patients) Control Group (30 patients) 33. 3 37. 6 Total length of stay (hours) 998. 7 1129. 2 Average cost of medication $1. 32 $2. 27 $223. 67 $515. 22 12. 3 18. 6 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 Total cost of medication Average strength of opioids administered (mme) Total strength of opioids consumed (mme) Decrease in: Length of stay Medication costs Opioids received Strength of opioids administered Average RN administration frequency of opioids Pain level after four hours

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-publichealth-emergency-address-national-opioid-crisis. html