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A Multimodal Analgesic Pathway Improves Postpartum Pain Management Scores as Reflected by HCAHPS scores

Jamie D. Murphy, Michael C. Grant, Christopher L. Wu and Linda M. Szymanski

Background: Postpartum pain is an important issue in obstetrics. A standardized method of monitoring pain scores is provided by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national survey. In an effort to improve pain management ans subsequently improve HCAHPS scores in our obstetrics unit, we implemented a multimodal analgesic pathway with the intent to maximize analgesia while minimizing opioid use.
Methods: Traditional postpartum analgesia methods were replaced with a multimodal pathway, including patientcontrolled epidural anesthesia for the first 12-24 hours after cesarean delivery plus acetaminophen and ketorolac IV as needed. Upon initiation of oral intake, scheduled acetaminophen and ibuprofen are administered. Transdermal lidocaine patches and opioids are added as needed. The oral medication pathway is initiated following vaginal delivery. Baseline and post-implementation responses to HCAHPS pain management questions 1) How often was your pain well controlled? 2) How often did the hospital staff do everything they could to help you with your pain were compared.
Results: Prior to analgesia protocol implementation, pain management scores were below the desired benchmark of 78%. Post-implementation, responses of “Always” or “Top-box” for Question 1 significantly increased [73% versus 65%; p=0.05]. Post-intervention Top-box responses for Question 2 increased from 82% to 89% (p<0.03).
Conclusions: The development of a postpartum multimodal analgesic regimen resulted in significantly improved pain management scores, reflected by HCAHPS scores. No other systematic intervention occurred to explain these positive changes.