Management of acute post-operative pain, particularly for patients with knee replacement, remains a significant challenge. Poorly managed pain can negatively affect a patient’s functional ability, sleep, emotional and psychological health, participation in rehabilitation, satisfaction, and overall recovery. As a physiotherapist working in the outpatient musculoskeletal program, Amy and her peers would often spend their therapy time fielding questions and concerns regarding pain management from patients recently discharged from hospital following a total knee replacement. They also noticed that patients were missing therapy appointments because their pain was not well managed. These concerns were echoed in an internal study where patients identified concerns and a lack of information regarding addiction and proper use of medication (including weaning), and dealing with side effects. Patients also noted the need to access this information in various formats. With lengths of inpatient stays decreasing (approximately 2-3 days post total joint replacement), the need for patient education regarding pain management, particularly post-discharge, is critical to improve outcomes for this patient population.
Amy’s project aimed to improve the patient experience for pain management post-discharge by developing education materials to address patients’ needs, and to implement this education into the discharge process. Using a co-design approach, Amy developed, together with five former patients, a short video and written pamphlet regarding pain management, with a particular focus on what to do once they are discharged from hospital. The content of the materials was based on information gleaned from the qualitative study conducted within the hospital, expertise from the Interprofessional Pain Management Committee, and from discussions with a number of patients on their experiences with pain management following discharge. Patients had input not only into the content of the information, but also the format, presentation, and flow of materials. The multiple formats help patients to access the information how and when they need it.
The educational materials help to augment the education already provided by nurses and the Acute Pain Service. Written materials are included with the discharge pain medication prescription, and have since become a standard of practice for the team, as almost all patients following knee/hip replacement now receive the materials. Patients report a high level of satisfaction (>90%) with the information provided in the materials. Preliminary evaluation of the experience of patients receiving outpatient care at the Holland Centre indicate improvement in their experience with pain management post-discharge following the implementation of these education materials; improvement in pre-post pain management experience scores may be even greater in those outpatients that receive care elsewhere who do not have the same access to this specialized care. This project also helped to foster interprofessional knowledge about pain management, and team collaboration to improve the patient experience. The educational materials are also available through the Sunnybrook website, as well as through an interactive mobile application.
Through multiple dissemination opportunities, Amy has provided education to staff about the content and availability of these materials for the total joint populations at Sunnybrook, and the use of these materials have now been integrated into current discharge processes. These materials, as well as the processes used to develop and implement them, act as a template for education regarding pain management for other surgical populations. The Interdisciplinary Pain Management Committee now plans to amend these materials for patients who have shoulder surgery. Amy plans to evaluate the patient video created in the project, and continues to disseminate results of this project internally within Sunnybrook, and has been invited to other external forum to present results of this initiative.
Amy’s peers have always seen her as a leader, as the person willing to take on ‘extra’ projects beyond her clinical role as a physiotherapist. However, the opportunity to be a fellow allowed her to take leadership for her own initiative from start to finish, an improvement initiative supported by her leadership team as important and valuable for patient care. This experience has given her a fresh perspective on her own leadership capabilities, as she has gained confidence to now take on bigger roles, consider change management and quality improvement processes, and communicate effectively through presentations and in meetings to share ideas and get the work done. The fellowship also increased her exposure to other leaders, and network with others not traditionally in her scope, including media relations and other team members, such as the inpatient MSK team and anesthetists. This networking has afforded new opportunities, such as being a part of a research group with anesthetists related to pain management. Like many other fellows, Amy wants to stay in touch with the clinical aspects of her role, but can also envision herself in a leadership position to improve the care within her program.
Amy speaks of her network of fellows, a very supportive small group that had the opportunity to bond over the six-month fellowship, who encouraged and supported each other and offered varying perspectives and resources from differing professions and organizations. Her initiative was also supported by the Interprofessional Pain Management Committee that helped to provide the infrastructure needed to move her project forward, to implement and sustain the work.
In an effort to collaborate with former patients on this project, Amy created a small patient advisory group that could be consulted to get their feedback. Amy is now part of the group establishing a Patient and Family Advisory Council at the Holland Centre. The advisory council provides a structure to obtain patient and family input on a number of issues related to the care of patients with total joint replacements, and patient education materials (e.g. website development, content for education). Implementing a patient advisory council is something that has been on Amy’s radar since she attended an Institute for Patient and Family Centred Care conference two years ago; her project provided the impetus to formalize this arrangement to engage with patients on a regular basis, and develop the infrastructure for patients to be involved on a number of initiatives throughout the Holland Centre.
If you had one minute to speak about the fellowship, what would you say?
“The fellowship is an opportunity that improves not just the patient experience, but also the development of staff. It gives staff the opportunity within the organization, they know where the gaps are, and it’s taking those staff who are enthusiastic and engaged members of the team, to invest and develop them in terms of leadership and management qualities.”