Developing an Implementation Plan
Anterior cruciate ligament (ACL) reconstruction is one of the most common and painful orthopedic surgeries. The adult population is especially exposed to prolonged pain lasting up to at least two weeks. The current popular form of relieving the post-operative pain emanating from anterior cruciate ligament reconstruction is the use of morphine, a strong opioid. However, morphine is not effective in reducing the pain on its own and tends to expose anterior cruciate ligament adult patients to diverse side effects including itchiness, nausea, constipation, and drowsiness. In tandem with this implementation project, Sahin, Sahin, Gul, and Mandollu (2012) confirm that peripheral nerve blockade is the suggested new solution that will help to alleviate pain among ACL reconstruction patients within a period of two weeks. The goal in this case is to ensure that postoperative pain arising from anterior crucial ligament is managed properly compared to how it is down at the moment. Thesis: Peripheral nerve blockade, as the suggested new solution, is effective in the management of postoperative pain among ACL reconstruction patients compared to the use of morphine because it improves patient outcomes.
Methods of Obtaining Approval and Support for Proposal
It will be necessary to obtain approval and support for this proposal from the organization’s leadership and other staff members. The key method that would be used to obtain approval of the proposal is filling the ethical patient approval application form relating to ACL reconstruction patients. Kirksey, Haskins, Cheng, and Liu (2015) affirm that this will be a vital step to gain approval for the proposal because it is indicative to the commitment to healthcare ethical standards when applying the new intervention to ACL reconstruction patients. The leadership will approve the proposal based on its ability to uphold and promote the ethical standards while solving the existing problem.
Support for the proposal will be obtained by highlighting its advantages to ACL reconstruction patients by the time it is fully implemented. The advantages arising from the proposal will be explicitly presented to both the leadership and staff, hence, enabling them to understand that something needs to be done to revolutionize the existing practice (using morphine) to alleviate pain among adults who have undergone anterior cruciate ligament. Thus, they will support the project for its good course.
Description of the Current Problem/Issue Requiring Change
According to Paech (2015), post-operation pain arising from anterior cruciate ligament reconstruction among adults is one of the worst experiences for a patient, and has the potential to lead to the readmission of individuals within 24 hours after operation. Beh, Hasan, Lai, Kassim, Zin, and Chin (2015) emphasize that inefficient approaches to post-operative pain endanger the safety of the patients and this is tantamount to negative patient outcomes. The key problem here is that intravenous morphine is being used as the main pain reliever for ACL reconstruction patients within a period of two weeks. However, intravenous morphine has not played its role of relieving pain effectively among patients, as it cannot be reliably used on its own. With the inability to work on its own, it necessitates a multimodal. Moreover, it cannot be used for extended periods of time to relieve the post-operative pain among patients. Benyamin, Trescot, Datta, Buenaventura, Adlaka, Sehgal, Glaser, and Vallejo (2008) assert that apart from the fact that intravenous morphine cannot alleviate pain on its own, it exposes patients to numerous side effects that could be detrimental to their health. For instance, it exposes some patients to itchiness because it triggers the release of histamine. Other potential side effects associated with intravenous morphine include constipation, drowsiness, nausea, addiction, and confusion in some instances. Hadzic, Karaca, Hobeika, Unis, Dermksian, Yufa, Claudio, Vloka, Santos, and Thys (2005) agree that it essentially affects the expected patient outcomes by exposing them to more risks with such side effects. Therefore, there needs to be an urgent change in the use of intravenous morphine as the key post-operative pain management strategy for ACL reconstruction adult patients.
Description of the New Solution to Address the Deficit
In light of the problems associated with intravenous morphine, peripheral nerve blockade is suggested as the new solution to deal with the post-operative pain among adult patients who have undergone anterior crucial ligament reconstruction within a period of two weeks. Vandebroek, Vertommen, Huyghe, and Houwe (2014) explain that peripheral nerve blockade entails the deliberate interruption of pain signals travelling along a nerve to the brain with the aim of relieving pain. It is usually long-lasting and involves the injection of an anesthetic or a corticosteroid into a nerve. O’Donnell and Szucs (2014) explain that the most remarkable thing about peripheral nerve blockade is that it is effective in postoperative pain management where there is prolonged and unbearable pain for ACL reconstruction patients. Thus, according to Dahl, Spreng, Waage, and Raeder (2012), this solution is directly applicable in this period under consideration where pain is deemed to persist for a prolonged period of two weeks among adult patients.
Rationale for Selecting the Proposed Solution
The first significant rationale for selecting peripheral nerve blockade is that nerve blocks are more effective in relieving severe pain among patients who have undergone anterior cruciate ligament reconstruction. As noted before, ACL reconstruction is one of the most painful surgeries that individuals undergo. Vandebroek, Vertommen, Huyghe, and Houwe (2014) opine that the severe pain the patients undergo could only be relieved through nerve blocks through the interruption of the transmission of pain signals through the nerve to the brain. Paech (2015) assert that the effective role it plays in the reduction of pain goes a long way into improving patient outcomes while at the same time reducing readmissions by more than 40%.
Secondly, peripheral nerve blockade is selected based on the rationale that it can be used for prolonged periods without severe side effects on patients. Kuthiala and Chaudhary (2011) explain that as opposed to intravenous morphine, peripheral nerve blockade is more reliable for use within the two-week period in the course of relieving the post-operative pain that ACL reconstruction patients are exposed to immediately after the operation.
Incorporation of Evidence from Literature Review
The review of literature from module 2 sheds light on the effectiveness of the peripheral nerve blockade. For instance, Paech (2015) affirms that peripheral nerve blockade should be appropriated in postoperative pain management because its risks are controllable compared to the risks posed by strong pain relievers such as morphine. Paech (2015) specifically supports the adoption of peripheral nerve blockade with the emphasis that it is primary to the recovery of patients and that it might go a long way into cutting down the number of readmissions by 40%.
Moreover, Hasanbegovic, Kapur, Cosovic, Kulenovic, and Mornjakovic (2012) point out that the prevalence of pain stands at 98% and that peripheral nerve blockade is the only effective way to deal with postoperative pain among patients. Hasanbegovic, et. al (2012) advocates the use of peripheral nerve blockade by asserting that it is not associated with side effects such as nausea and drowsiness that are usually encountered by patients using morphine. Therefore, such side effects should be overcome by appreciating the use of peripheral nerve blockade as opposed to morphine.
From the literature review, Bailard, Ortiz, and Flores (2014) also support the adoption of peripheral nerve blockade as the most effective strategy for severe pain management among patients who have undergone operations. They advance the case for the adoption of peripheral nerve blockade with the understanding that ineffective management of the pain results in high rates of hospital readmissions among patients.
Description of Implementation Logistics
The change will be integrated into the current organizational structure within one week. It is critical to understand that it will be integrated into the organizational structure through the change of the goals and objectives of the organization in terms of the management of postoperative pain among ACL reconstruction patients. As Antwi and Kale (2014) confirm, the goals will be changed to the direction of relieving severe pain within a prolonged period of at least two weeks, hence, leading to satisfaction among patients in terms of outcomes.
Additionally, the change will be integrated into the organizational culture within the first week. It will be integrated through the change of policy and strategy of pain management. This means that there will be a strong statement forbidding the use of morphine in the management of postoperative pain among ACL reconstruction patients. Everyone will need to follow this culture for uniformity in moving towards the realization of better patient outcomes.
Lastly, the change will be integrated into the workflow immediately after it is approved. This means that if it is approved on the first day, then it will be integrated within the same day. As Kuthiala and Chaudhary (2011) explain, it will be integrated into the workflow by changing the whole procedure of managing postoperative change among ACL reconstruction patients. No more opioids, especially morphine, will be used in the process of pain management.
The research and development team working in collaboration with the management will initiate the change within the organization by informing every party involved. In the opinions of Antwi and Kale (2014), the research and development team will work with the management to initiate change because they are in charge of proving the required resources such as finances. More so, staff will be educated by the research and development team. The education will be conducted in tandem with their research and the results that are expected from the use of peripheral nerve blocks in postoperative pain management in ACL reconstruction patients.
The management in charge of operations will be responsible for overseeing the implementation process in the organization. The management team will focus on the suggested aspects of the solution and some of the best solutions that could be realized. They will measure if employees are working toward the goal as required.
Resources Required for Implementation
Assessment tools, especially the questionnaire, will be used to test the knowledge of the participants at the baseline and after the intervention. The questionnaire will capture several elements including the costs and technology that is involved in the organization. The questionnaire will be as follows.
Measuring Participant Knowledge at Baseline
- How do you rate the efficiency of morphine as a strategy of managing postoperative pain among ACL reconstruction patients on a scale of 10?
- What were the patient outcomes when morphine was used?
- Could you estimate the costs involved in purchasing learning materials to educate staff about the application of morphine in postoperative pain management?
- Which members of the staff were involved in the administration of morphine opioids to patients?
- What was the level of patient readmission when morphine was being used?
- What technologies did the organization have in place at this time?
Measuring Participant Knowledge after Intervention
- Could you describe what peripheral nerve blocks entails?
- What was the rate of patient readmission when peripheral nerve blocks were used as compared to when morphine was used?
- Was the software technology that was able to capture the change in the rates of readmission available in the organization?
- What is your experience in using peripheral nerve blocks as the new strategy for managing postoperative pain among patients?
- Do you think that the stated costs of collecting and analyzing data and purchasing materials to educate staff about peripheral nerve blocks is high compared with the benefits being realized in terms of patient outcomes?
- Give your general opinion on peripheral nerve blocks as a pain management strategy for ACL reconstruction patients.
Apart from questionnaires, educational materials, especially the pamphlet would be used in passing across relevant information associated with peripheral nerve blocks as a postoperative pain management for patients. It will be instrumental in highlighting the costs, technology, and staff as key resources to implementing the proposed strategy. The pamphlet is attached.
In conclusion, it is a high time the organization realized the need to improve pain management among ACL reconstruction patients using the peripheral nerve blocks. It is clear that intravenous morphine does not work efficiently in cases of prolonged pain and that it comes with numerous undesirable side effects such as nausea. The patient outcomes and recovery need to be continuously improved using a prolonged strategy of pain management in this case, peripheral nerve blocks. This will go a long way into reducing the rate of patient readmissions within 24 hours of operation by at least 40%. The change should be embraced positively by all members of the organization starting from the leadership.