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Title: Development of a management algorithm for post-operative pain (MAPP) after total knee and hip replacement: study rationale and design.
Epworth Authors: Botti, Mari
Redley, Bernice
de Steiger, Richard
Holcombe, Marlene
Cohen, Emma
Other Authors: Kent, Bridie
Bucknall, Tracey
Duke, Maxine
Johnstone, Megan-Jane
Hunter, Susan
Considine, Julie
Keywords: Pain
Pain Management
Post-operative Pain
Orthopedic Surgery
Evidence Based Practice
Clinical Decision Making
Total Knee Replacement
Arthroplasty, Replacement, Knee
Total Hip Replacement
Arthroplasty, Replacement, Hip
Surgery, Orthopedic
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Chair of Nursing - Deakin University
Epworth/Deakin Centre for Clinical Nursing Research, Melbourne, Victoria, Australia.
Issue Date: Aug-2014
Citation: 2014 Aug 28;9: 110
Abstract: Background: Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. Methods: In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. Discussion: The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts. Keywords: Pain, Pain management, Post-operative pain, Algorithm, Orthopaedic, Evidence-based practice, Clinical decision making, Clinical decision making.
DOI: 10.1186/s13012-014-0110-3
PubMed URL:
ISSN: 1748-5908
Journal Title: Implementation Science
Type: Journal Article
Affiliated Organisations: Australian Orthopaedic Association – National Joint Replacement Registry
Australian Orthopaedic Association
Royal Australasian College Surgeons
Centre for Quality and Patient Safety Research, Faculty of Health, Deakin University, Burwood, VIC, Australia.
Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
Royal College of Nursing, Australia
Australian Nursing Federation
College of Emergency Nursing Australasia
Interational Society for Quality in Healthcare Association
African Federation for Emergency Medicine
Type of Clinical Study or Trial: Clinical Trial
Appears in Collections:Musculoskeletal
Pain Management

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