Introduction
Care delivery is an incredibly complex process, which requires the active involvement of both healthcare providers and patients in order to achieve the best outcomes. Without any doubt, evidence plays a critical role in it, as it helps the former to identify practical approaches and the latter to feel safer. It underpins care delivery by improving the quality of the decisions made by medical staff and encouraging patients to trust healthcare providers.
The organization and observation of the day surgery patient pathway from the ward to a post-anesthesia care unit (PACU) are essential to recognize the power of evidence. Undoubtedly, one of its most vital aspects is pain management in enhanced recovery after surgery (ERAS), which aims to reduce patients’ surgical stress responses. It requires the analysis of much current research evidence, guidelines, and local policies to be appropriately and adequately conducted. The role of an operating department practitioner (ODP) within the process is significant; thus, he or she must be aware of the considerable power of evidence and know how to use it effectively.
What?
It is essential to undertake the reflection on the day surgery patient pathway in order to be able to improve it in the future. The observation offered multiple valuable insights, which need to be carefully reviewed. To begin with, the patient was an eighty-two-year-old man who had been suffering from Crohn’s disease for a long time and was diagnosed with cancer. Therefore, the man needed to undergo a laparoscopic right hemicolectomy to eliminate health issues. This advanced cancer surgery required adequate postoperative pain management. Medical staff had to adopt evidence-based approaches to reach the best results.
Besides, after preoperative medical assessment, the patient was admitted for day case surgery. Healthcare providers collected polyps, which are growths on the lining of the colon, during the screening for colorectal cancer (Khatri, 2020). They might obstruct the normal bowel movement and even turn into cancer. The patient noted that he occasionally experienced such symptoms as griping pains in the abdomen and a bloated stomach, found it challenging to get constipated, and felt sick. The preoperative team, including the anesthetist, surgeons, and nurse, thoroughly examined the patient before the operation. They were ready to provide high-quality patient care and alleviate the man’s pain.
It is essential to note that, after the visit of the preoperative staff, the patient started to feel anxious, and it was likely to heighten the pain experience. The nurse endeavored to reassure the male and gave him a leaflet on postoperative pain management, which provided a recovery plan.
The anesthetist explained to him what analgesics are available, as mild and moderate pains are usually treated with them (Shiel, 2018). He also talked with the patient about what he could expect after the operation and reviewed all the possible concerns. In addition, the patient was elderly, suffered from chronic pain due to several comorbidities, smoked, and had occasional drinks. The previous operations and possible concurrent deep vein thrombosis (DVT) on the left leg also influence the male’s condition. Therefore, the anesthetist had to consider many different factors before prescribing the drugs.
Furthermore, the patient was prepared and taken into the operation room. Before the anesthesia, the ODP and nurse arranged the drugs, needles, and syringes. They were aware of the standards of proficiency and endeavored to manage their workload, as well as resources, effectively (“The Standards of Proficiency,” 2018). Gustafsson et al. (2019) note that “spinal anesthesia has a high efficacy and relatively low complication profile, and it has been used to facilitate ultra-rapid recovery after laparoscopic colorectal surgery” (p. 676). However, the anesthetist prescribed abdominal wall blocks instead of it, as the patient suffered from several comorbidities and was taking different medications, such as dalteparin for DVT. Besides, he used total intravenous anesthesia (TIVA) instead of gas inhalation. The anesthetist’s decisions were based on current research evidence and professionals’ guidelines.
Finally, the recovery ODP monitored the patient’s condition after the operation. She prepared patient-controlled analgesia (PCA) pumps, understanding that “the chore of medicine is to preserve and restore patient’s health and to minimize their suffering” (Kumar & Elavarasi, 2016, p. 87). Therefore, healthcare providers need to acknowledge the significance of pain management. The practitioner explained to the male how the PCA pumps function and how to manage his pain correctly. Evidently, social conditions and preoperative comorbidities would primarily affect the patient’s recovery.
So What?
After reviewing the observation, it is essential to analyze the errors and achievements of the day surgery patient pathway. It is evident that the professionalism and fantastic teamwork of healthcare providers helped the patient to go through the operation without complications and with minimal pain. It is stated that patients must be provided with colorectal cancer information about their treatment in both written and spoken forms in a sensitive and timely manner (“Colorectal Cancer: NICE Guideline,” 2020).
It is also clear that their needs and circumstances should be considered as well. The man under the observation received enough information, and numerous different personal aspects were carefully analyzed by the whole team, especially by the anesthetist. In addition, Carr and Thomas (1997) concluded that the lack of information, ineffective pain control, and inadequate pain assessment cause patients to experience significantly greater than anticipated postoperative pain intensity. Every staff member was aware of it and worked diligently to prevent such adverse outcomes.
Moreover, it became evident that pain management is crucial, since if it is inadequate, the risk of complications and adverse effects is extremely high. For instance, the consequences of postoperative pain may include decreased lung function, chest infections, increased heart rate, hypertension, low venous return, nausea, vomiting, depressed mood, withdrawal from social interactions, and anxiety. Besides, Macintyre and Schug (2014) note that “patient satisfaction is often used as an indicator of ‘good’ or ‘bad’ pain relief” (p. 21). Fortunately, the observed man did not experience any of the symptoms mentioned above and appeared to be satisfied after the operation. Hence, it may be concluded that pain management was conducted successfully in this case.
In addition, the personal needs and circumstances of the patient were analyzed to approach pain management effectively. According to Gwinnutt and Gwinnutt (2017), patients’ responses to pain should be understood against their background rather than compared with the norm. The team of healthcare providers took it into account and thoughtfully explored the observed male’s comorbidities, lifestyle, and taken medications. For instance, the anesthetist prescribed him abdominal wall blocks in spite of ERAS guidelines. The reason for it was that the man used dalteparin injections, which may lead to fatal consequences in combination with spinal anesthesia. In addition, the anesthetist did not include gas inhalation in order to avoid coughing and postoperative nausea and vomiting (PONV).
Now What?
After reviewing and analyzing the observation of the day surgery patient pathway from award to PACU, it becomes apparent that evidence plays a decisive role within healthcare. Undoubtedly, pain management should always be supported by current research, guidelines, and policies. An ODP needs to be aware of it and work diligently to relieve patients’ pain and increase their satisfaction. Several conclusions were made when the observation was finished.
First, patients need to be adequately informed about pain management before the operation, as it primarily affects their overall experience. Preoperative teams have to do their best to address all patients’ concerns and provide useful guidelines. Tan (2015) notes, “this enables better recovery and improves pain relief postoperatively” (p. 79). Therefore, more attention should be paid to the issue, and healthcare providers have to consult individuals properly before surgery. Second, it is vital to consider patients’ comorbidities, lifestyles, and personal circumstances while managing their pain. The combination of different drugs may lead to adverse consequences.
Bad habits, such as smoking, drinking, and binge eating may cause various side effects. Hence, medical staff should explore patients’ backgrounds thoughtfully and find the most efficient ways to approach the treatment process. They should be observable and pay attention even to minor issues in order to relieve patients’ pain as much as possible. Third, after surgery, postoperative teams have to examine patients’ conditions adequately and design the most appropriate ways to alleviate their pain and ensure a quick recovery. In PACU, patients should be closely observed, and their experience has to be carefully analyzed.
Conclusion
The observation of the day surgery patient pathway was an incredibly effective way to recognize the significance of evidence within pain management. The review and analysis of it were conducted, and conclusions for future practice were made. Undoubtedly, pain management is crucial, as it considerably affects patients’ satisfaction and overall experience. Current research and professionals’ guidelines suggest that healthcare providers should thoroughly inform patients about pain management before, during, and after surgery, carefully examine different factors, ranging from comorbidities to bad habits, and closely observe everyone after the operation.
Fortunately, much research was conducted on the topic, and medical staff should explore it to be able to design more effective approaches. In general, the reflection on the observation was a highly productive process, which helped to determine many valuable insights.
References
Carr, E. C., & Thomas, V. J. (1997). Anticipating and experiencing post-operative pain: The patients’ perspective. Journal of Clinical Nursing, 6(3), 191−201.
Colorectal cancer: NICE guideline. (2020). NICE. Web.
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F. … Liunggvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced recovery after surgery (ERAS) society recommendations: 2018. World Journal of Surgery, 43(3), 659−695.
Gwinnutt, C. L., & Gwinnutt, M. (2017). Lecture notes. Clinical anaesthesia. John Wiley & Sons.
Khatri, M. (2020). What you should know about colon polyps. WebMD.
Kumar, K. H., & Elavarasi, P. (2016). Definition of pain and classification of pain disorders. Journal of Advanced Clinical and Research Insights, 3(3), 87−90. Web.
Macintyre, P. E., & Schug S. A. (2014). Acute pain management: A practical guide. CRC Press.
Shiel, W. C. (2018). Medical definition of pain management. MedicineNet.
Tan, K.-Y. (Ed.) (2015). Transdisciplinary perioperative care in colorectal surgery: An integrative approach. Springer.
The standards of proficiency for operating department practitioner. (2018). HCPC. Web.