Penn Medicine boasts one of the largest electrophysiology programs in the United States, performing more than 2,700 arrhythmia procedures per year at the Hospital of the University of Pennsylvania (HUP) alone.
Electrophysiology (EP) procedures vary in invasiveness and while complications are low, patient experiences related to post procedure pain can vary dramatically and make a major impact on patient safety and satisfaction.
“Our patients’ comfort, satisfaction, and safety are a top priority,” says Michael Riley, MD, PhD, assistant professor of Medicine and a member of Penn’s Cardiac Arrhythmia Program. “We are always looking at new ways to improve care before and after a procedure.”
To address the issue of post EP procedure pain, Dr. Riley, Nancy Cash, DNP, CRNP, APN-C, and Jo Anne Fante-Gallagher, MHA, BSN, RN, CPHQ, administered a survey to HUP patients who had undergone an EP procedure to gain more first-hand knowledge of the patients’ perspectives and identify critical needs on which to base new approaches for therapeutic intervention.
They recently presented their findings at the 2014 Heart Rhythm Society’s annual meeting.
Nancy Cash, DNP, CRNP, APN-C at the HRS meeting with Francis Marchlinski, MD, professor of Medicine and Director of Electrophysiology at Penn.
“When we started the survey, we knew that only 60 percent of our patient population felt their pain was always well controlled. So we needed to figure out the root cause of the problem and work towards an innovative solution,” Dr. Riley says.
The survey found that almost half of the patients said the primary site of pain was their back. And a third of the patients also said the pain they experienced was more than they anticipated before the procedure. After a little more digging, the researchers realized that the source of most of this back pain occurred during the few hours of bed rest that patients are required to perform during the initial recovery process.
“To really make the situation better, we knew we had to work with the entire care team, not just our own staff in EP. The adage ‘it takes a village’ was very much applicable in this scenario,” Riley says. The “village” that cares for EP patients includes cardiologists, nurse practitioners, physician assistants, anesthesiologists, pharmacy and nurses from the recovery unit where patients are held in the immediate post procedure period and the cardiac intermediate care unit (CICU) where patients are admitted after recovery.
After getting input from the entire team, researchers decided that a straightforward way to improve post procedure back pain would be to implement protocols that would decrease the length of bed rest for eligible patients and improve pain medication orders to specify pain levels of mild, moderate and severe to offer the most individualized pain relief possible.
The team also included non-medication interventions, such as offering low back massage, lower back and knee support, and earlier elevation of the head of bed for patients during the recovery period.
Throughout the entire implementation process extensive education was provided to all members of the care team regarding the mechanisms and treatments of acute pain and how it differs from more chronic pain.
A year after the survey and the new measures were put into place, new scores show that 90 percent of patients reported their pain was well controlled.
“I think our efforts resulted in a major win for our patients and our staff,” Riley says. “By working as a team, we were able to make smart and helpful adjustments to our care process.”