JMIR Publications

ABSTRACT

Background:

Best practice guidelines recommend educating surgical patients about non-pharmacological pain care techniques that can be used in addition to pain medication for peri-operative pain management, given the risks for opioid misuse following surgery. As part of the parent Non-pharmacologic Options in post-operative Hospital-based and Rehabilitation pain Management (NOHARM) clinical trial, we implemented the Healing After Surgery (HAS) initiative, which leveraged the Epic electronic health record (EHR) to provide patients with education on non-pharmacological pain care (NPPC) techniques peri-operatively. We disseminated educational materials directly to patients via the EHR patient portal and prompted patients to select the ones they were most interested in using, which auto populated the EHR so that their care team could view their preferences. We also built clinical decision support (CDS) elements in the EHR to prompt and support inpatient nurses in providing patients with education and reinforcement for using their preferred NPPC techniques.

Objective:

The present study evaluated nurses’ perceptions of barriers and facilitators to implementing the EHR-based HAS initiative.

Methods:

We invited inpatient nursing leaders and bedside nurses to participate in a semi-structured interview. Inpatient nursing leaders were invited to complete a brief survey that asked them to rate their agreement with seven items using a numeric rating sale (1 = not at all, 10 = a great deal).

Results:

We received survey responses from n = 47 nursing leaders who indicated that their staff knew about the HAS initiative (mean = 7.53, SD= 1.77) and what they were expected to do (mean = 7, SD = 1.88). They thought the HAS initiative supported patients’ pain management needs (mean = 6.76, SD = 2.24), endorsed it as a priority (mean = 7.02, SD = 2.56), and encouraged staff to support it (mean = 5.98, SD = 2.78). They indicated staff experienced some burden supporting the initiative (mean = 3.93, SD = 2.47), but supported some variation of the initiative continuing once the parent trial ended (mean = 7.72, SD = 2.62). Interview findings from n = 29 nurses revealed: 1) nurses gravitated towards providing NPPC techniques they were familiar with, 2) the initiative was patient-centric with opportunities to better engage patients, and 3) nurses experienced challenges implementing and prioritizing the intervention in the inpatient setting due to competing demands in a pandemic and post-pandemic environment. Interviews revealed mixed effectiveness of implementation strategies.

Conclusions:

Nurses understood the intervention’s benefit but struggled to implement unfamiliar NPPC techniques and prioritize the initiative due to other clinical demands. Additional implementation strategies may be needed to better engage patients and facilitate intervention delivery. Clinical Trial: This study was registered on Clinical Trials, https://clinicaltrials.gov, NCT05166356