Association of a nurse-led closed-loop pain management workflow with early postoperative pain outcomes in orthopaedic inpatients: A single-centre retrospective pre-/post-implementation study
Jie Yan, Ling Yang, Junyan Liu, Danhua LouBackground
Early postoperative pain can impede mobilisation after orthopaedic surgery. We evaluated whether a nurse-led closed-loop pain-management workflow was associated with improved care processes and early pain outcomes.
Methods
This single-centre retrospective pre-/post-implementation cohort study included adult orthopaedic inpatients returning to standard ward care. The workflow specified numerical rating scale (NRS, 0–10) documentation, escalation for NRS ≥4, and reassessment within 30–60 minutes after rescue analgesia. The primary outcome was ineffective pain control within 0–24 h, defined as any NRS ≥4. Secondary outcomes included 0–48 h pain control, peak rest and movement-evoked pain, adverse events, rescue/opioid exposure, and inpatient satisfaction. Multivariable logistic regression and sensitivity analyses were performed.
Results
Among 206 patients (pre-implementation n=98; post-implementation n=108), pain assessments increased from a median of 4.0 to 6.0 (P<0.001), and movement-evoked pain documentation increased from 34.7% to 72.2% (P<0.001). In the time-stamped subset, median time to first rescue analgesia decreased from 55 to 30 minutes (P<0.001), while closed-loop completion increased from 37.8% to 80.0% (P=0.002). Ineffective 0–24 h pain control decreased from 38.8% to 24.1% (P=0.023), and peak movement-evoked pain decreased from 6.0 to 5.0 (P<0.001). High satisfaction increased from 67.3% to 80.6% (P=0.030). Post-implementation status remained associated with lower odds of ineffective pain control (adjusted OR 0.53, 95% CI 0.29–0.96) and higher odds of high satisfaction (adjusted OR 1.92, 95% CI 1.03–3.60).
Conclusions
A nurse-led closed-loop pain-management workflow was associated with more timely pain-care processes and improved early postoperative pain outcomes in orthopaedic inpatients.