Transforming Care to Evidence-Based Practice With Scripted Messages: An Improvement Project for Pain Management in Outpatient Surgical Patients.

BACKGROUND: Outpatient surgeries are common and most patients experience pain postoperatively requiring nursing attention to pain management. Scripting, recommended for consistent, targeted communication to improve patient satisfaction, has limited evidence to support its use.

AIMS: To explore the effect of scripted messages on self-reported pain control and patient satisfaction with care in outpatient surgical patients.

METHODS: A retrospective medical record review pre- and postintervention evaluated a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis compared patient reports of pain control and patient satisfaction with care 48 hours postdischarge from outpatient surgical procedures.

RESULTS: A total of 231 records (98 preintervention; 133 postintervention) were analyzed. The sample included 144 (62%) male, 156 (68%) married with mean age of 57.6 (SD = 16.1) years. The majority (90%) received general anesthesia, and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the postintervention group (mean rank = 62.66) compared to the preintervention group (mean rank = 51.95), U = 1,258, p = .01 with an effect size φ = .223.

LINKING EVIDENCE TO ACTION: A scripted message showed statistical significance and a small clinical effect in pain control that adds to the body of knowledge around the effectiveness of scripting delivered by nurses. Although it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues around similar study designs will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Resistance to change when evidence is not robust may be especially difficult related to scripting, often perceived as a mandated intrusion into the nurse-patient relationship.