Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Melanie Brewer

Second Advisor

Dr. Corinne Cochran

Abstract

Problem: Postoperative pain management in pediatric orthopedic patients is often inconsistent due to variability in provider practices and a lack of standardized protocols. At a Central Texas pediatric orthopedic clinic, all patients received opioid prescriptions post-knee surgery regardless of procedure severity, leading to frequent caregiver calls for clarification. This practice revealed a critical gap in preoperative education and multimodal pain management strategies, contributing to patient safety concerns and increased clinic workload.

Aim of the Project: The primary aim of the project was to improve pain control, reduce opioid reliance, and decrease postoperative pain-related follow-up calls by implementing a standardized, evidence-based multimodal pain management bundle.

Review of the Evidence: A comprehensive literature review showed that multimodal strategies, combining non-opioid medications and non-pharmacologic methods, significantly improve pain outcomes and reduce opioid use. Preoperative education was identified as essential for enhancing caregiver understanding and reducing postoperative confusion.

Project Design: The quality improvement project utilized the Institute for Healthcare Improvement’s Plan-Do-Study-Act cycles and the OhioHealth Change Management Model to guide structured testing, stakeholder engagement, and change readiness throughout the 12-week implementation. The lead APRN provided standardized preoperative education using evidence-based materials. The orthopedic surgeon aligned prescribing practices with the project. Key stakeholders included the APRN, surgeon, nurses, and administrative staff.

Intervention: An evidence-based pain management bundle adapted from Michigan Medicine’s pediatric protocols was implemented. Staff education, bilingual materials, non-opioid strategies, and a standardized checklist were included. The bundle was applied to pediatric patients ages 5 to 18 undergoing knee surgery. Data were collected from the electronic health records, and a secure Excel tracking tool was utilized.

Significant Findings/Outcomes: Postoperative pain scores averaged 3.55 on a 10-point scale, with no opioid refill requests. The average duration of opioid use decreased from 7 days to 3.04 days. Preoperative education was completed for all patients, yielding 100% compliance. Although 38.5% of caregivers made follow-up calls, these were unrelated to pain management, suggesting the intervention effectively supported families. No adverse outcomes were reported.

Implications for Nursing: This project demonstrates the role of advanced practice nurses in leading evidence-based improvements that enhance patient safety, standardize care, and support opioid stewardship. Alignment with the Institute of Medicine’s domains of effective, patient-centered, and timely care supports the Institute for Healthcare Improvement's Triple Aim by the bundle’s seamless integration into the clinic’s workflow and onboarding.

Rights

Copyright, all rights reserved

Download

Share

COinS