Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-based Practice Project
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2021 prov rn wa; 2021 prov rn poster; washington; spokane; pshmc
Dermatology | Nursing
Background: Cellulitis is an infection of the skin causing swelling and acute pain. Two and a half to three and a half million adults seek care in the emergency department annually for this condition. Opioid medications are commonly administered and prescribed for pain, especially following the Joint Commission’s campaign in 2001 characterizing “pain as the 5th vital sign”. An estimated 22% of older adults hospitalized with a painful medical condition receive a new prescription for an opioid medication. Evidence suggests that there is no difference in pain outcomes among adults prescribed opioid versus non-opioid medications for acute pain conditions in the ambulatory setting. Conversely, outcomes favor the use of non-opioids, particularly acetaminophen and non-steroidal anti-inflammatories (NSAIDs), compared to opioids in the treatment of acute pain. Furthermore, best practice guidelines for acute pain management published in 2018 recommend maximizing the use of non-opioids and minimizing the use of opioids. In two acute care hospitals in the Pacific Northwest, prescription pain management for adults treated for cellulitis was previously unknown.
Purpose/aims: Our aim was to determine whether the rate of inpatient analgesics administered to manage pain related to cellulitis changed between the years 2014- 2020 at two acute care hospitals before and after local opioid stewardship efforts.
Methods/Approach: Data were extracted and de-identified from two hospitals in the Pacific Northwest for adults 18 years and older admitted with primary or secondary diagnosis of cellulitis between the years of 2014 and 2020 for a length of stay between 1-7 days. These data were retrospectively analyzed using descriptive statistics, chi-square analyses, and t-tests in excel.
Results:A total of 4,523 records met criteria were included in analysis. In the sample, rate of inpatient opioid administration significantly decreased from 91% to 73% (p
Conclusion: Opioid administration significantly decreased over time in our sample, and non-opioids, particularly acetaminophen, were frequently administered. In these two hospitals, it appears that local opioid stewardship efforts led to decreased opioid administration in alignment with best practice guidelines for managing acute pain for adults hospitalized with cellulitis. Future work should be done to compare pain management strategies over time for other acutely painful, non-surgical conditions treated in the hospital, and to characterize pharmacological pain management strategies post-hospitalization for an acutely painful, non-surgical conditions.
Implications for practice: Nurses should educate patients on best practice guidelines for pharmacological treatment of acute, non-surgical pain. Nurses could also advocate to prescribers to optimize non-opioid pain medications, particularly NSAIDS if patients meet criteria, to manage acute pain in the hospital setting.
Conference / Event Name
2021 Providence RN Conference
Pham, Syndey; Bigand, Teresa; Senger, Brenda; Daratha, Kenn; and Daratha, Kris, "Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-based Practice Project" (2021). 2021 Providence Nurse Research Conference. 26.