Pain Control System in Siriraj Hospital Postanesthesia Care Unit (PACU)

Objective: To determine the current postoperative pain status in the postanesthesia care unit (PACU) and nursing practices that may affect pain relief outcomes. Methods: We performed a prospective observational study in 259 postsurgical patients who underwent general anesthesia only, and were admitted to 5 PACUs in Siriraj Hospital during official work hours. We silently observed the pattern of nursing management for postoperative pain according to the hospital work instructions (WIs). We interviewed the patients once about their pain scores (PSs) at the time they were discharged to wards. The man- power in each PACU was determined. All nurses working in 5 PACUs were asked to fill in the questionnaire. Results: The PS after gaining consciousness, the overall PS, and the PS at discharge time were (mean±SD) 1.3±2.9, 4.1±2.7 and 3.1±2.4, respectively. The time to re-evaluate PS after each intravenous analgesic, to determine the adequacy of treatment, was longer than was recommended, so were the time of giving the additional doses which were 21.9±16.7 minutes, and 20.9±14.7 minutes, respectively. Other instructions in the WIs were followed in >75% of these patients. The Registered Nurse-to-patient care ratio was 1:1.5 (0.2-8.0). Nurses considered that to adjust manpower according to the varied numbers of patients during the day could improve their work. Nurses’ attitude to intravenous analgesic administration was positive. Conclusion: The overall PS was 4.1±2.7. Pain control system in Siriraj Hospital PACU was mostly in accordance with the hospital WIs, except that the time to re-evaluate the adequacy of analgesia was too long. Adjusting the manpower to suit the varying workload during the day was suggested to improve their work. Keywords: PACU, pain, work instruction, workload Siriraj Med J 2014;66:82-90