Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

6. Oral care competency and practices among critical care nurses for mechanically ventilated patients

Oral care has an important role in maintaining the health and well-being of critically ill patients. Effective oral care improves patient comfort and prevents oral infection. Oral care also is an important component of the ventilator bundle. Evidence shows that comprehensive oral care is a prevention strategy to reduce the risk of ventilator-associated pneumonia in patients under mechanical ventilation. Purpose: This study was conducted to assess the critical care nurses’ competency pre, intra and post Endotracheal Tube and Oral Care Practices for Mechanically Ventilated Patients Methodology: A cross-sectional study was conducted on 150 intensive care nurses working in CCU, CSICU, and ICU of a specialized governmental hospital. A questionnaire was distributed and three weeks was given for papers collection. Three parts questionnaires were developed based on literature and an existing hospital policy and procedure. The first part contained questions about demographics including gender, age, years of working in critical care unit, qualification, and marital status. Second part contained a 12 items to test the nurses attitude toward mouth care practices for intubated patients by using 5-point Likert scale ranging from strongly agree (5) to strongly disagree (1). Part three contained a checklist to assess oral care competency by using a 5-point Likert scale ranging from strongly agree (5) to strongly disagree (1). All nurses participated voluntarily and were assured of confidentiality. Statistical Package for the Social Scientists (SPSS, version 17) software was used for analysis. Result: A total of 131 nurses out of 150 completed the questioners, 100% were females, 86% of nurses are Baccalaureate degree, 93% with 7–9 years’ experience in critical care units, 80% of nurses have adequate time to provide oral care at least once a day, 20.4% only of the nurses are using a toothbrush with 2% Chlorhexidine Solution every 2–4 h for oral care at least Once a Day, 75.8% of nurses prefer to use oral swab with 2% Chlorhexidine Solution q 2–4 h, 98% has positive attitude toward mouth care practice.Conclusions The survey provided useful information on the oral care knowledge and practices of nurses caring for Mechanically Ventilated Patients. Almost all the nurses perceived oral care to be a high priority. Very low number of nurses are using the toothbrush with 2% Chlorhexidine Solution every 2–4 h, this figure must be studied for further action. The majority of nurses had some formal training in oral care, but would appreciate an opportunity to improve their knowledge and skills