ThTP2.13 Improving analgesia on discharge after Oesophagectomy: A three cycle quality improvement project
Louis Fiander, Adam Lunt, Jacqueline Easter, William Carr, Richard Berrisford- Surgery
Abstract
Introduction
Oesophagectomy is a painful operation. Poorly controlled post-operative pain increases the risk of complications including pneumonia and venous thromboembolism. On discharge, patients become more active and have less regular reviews, both increasing the risk of uncontrolled pain. Adequate analgesia is essential. We aimed to assess practice relating to discharge analgesia following oesophagectomy, implement interventions to improve discharge prescribing, then re-assess.
Methods
Retrospective data were collected for patients discharged following oesophagectomy between 22/03/2021 and 09/11/2021. Data were analysed in three subgroups: pre-intervention; following education programme; and following introduction of e-prescribing “order-sets”. Intervention comprised of the formulation of a guideline for discharge analgesia (see Table 1), an education programme and implementation of an order-set. Discharge prescriptions from each subgroup were then compared to the guideline.
Results
Data for 53 patients were analysed. Subgroups contained 18, 17 and 18 patients respectively. Pre-intervention, 14% of discharge prescriptions met the guideline standard, 14% prescribed no analgesia and 38% prescribed Paracetamol alone. Following education, 82.4% of discharge prescriptions adhered to guidelines. Following order-set introduction, adherence was 83.3%.
Conclusions
Effective analgesia is essential following oesophagectomy. By formulating and disseminating guidelines, alongside an education programme and introducing order-sets we have demonstrated significant and sustained improvement in discharge prescriptions for oesophagectomy patients.