Taking a Cold Hard Look at Post-Operative Pain Management

Purpose: In response to the national opioid crisis, same-day dismissal surgical patients are being discharged with instructions to utilize over-the- counter analgesia and alternative pain management options instead of narcotics. Identifying alternative pain management therapies such as hot or cold interventions was necessary to help reduce patient pain postoperatively. There was neither a clear guideline nor orders from surgeons as to when hot or cold therapy was advised postoperatively. There were limited products for applying hot or cold therapies available on the outpatient unit. Literature search for applicable articles did not yield any pertaining to the applications of hot or cold therapies in the postoperative setting.

The purpose of this project was to identify patient populations that could utilize hot or cold therapy for postoperative pain management, identify the best methods for delivering these therapies, and utilize hot or cold therapies to improve patient perception of postoperative pain. IRB guidelines did not warrant IRB approval for this project.

Description: The project team contacted over 15 surgical teams to identify which types of surgeries would allow for hot or cold therapies. The project team contacted a nursing representative from each inpatient surgical unit and specialty within the hospital to benchmark current practices for hot or cold therapy utilization and what types of supplies they stocked. A pre- and post-intervention survey was completed by RNs and patients to identify level of pain, type of intervention (ice or heat for 20 minutes or neither), and RN and patient perceptions of pain relief.

Outcome: With feedback from the surgeons, a quick reference tool was created for nurses to identify which patients could utilize hot or cold therapy and was placed near all hot or cold therapy supply areas. After benchmarking with other surgical areas, a variety of additional hot or cold therapy options were added to unit floor stock, resulting in a 150% increase in usage. Surveys were completed by 100 adult same-day dismissal surgical patients, with 94 receiving hot or cold therapies (intervention group). The intervention group had 81% utilize ice and 19% utilizing heat.
Overall, the intervention group reported an average improvement in pain score of 1.4 points compared to the control group with a 0.2-point improvement (on a 0-10 pain rating scale). In the intervention group, 89% of patients reported the intervention as beneficial, and 80% reported their pain as better or much better. RNs reported subjective pain relief in 89% of patients. Neither patient nor RN’s reported worsening pain with intervention. Patients receiving pain medications within 30 minutes of intervention totaled 21% of the intervention group and reported an improved pain score of 2.1 points, with no difference in the reports of pain being better or much better.

In conclusion, creating a tool to identify patients that can utilize hot or cold therapies and increasing therapy options resulted in an increase in usage. Increased usage resulted in patients reporting reduced pain scores and improved pain perceptions with the addition of hot or cold therapy in the postoperative setting.