Utilizing a standardized pain management order set for patients undergoing uterine fibroid embolization (UFE) may decrease use of narcotics, reduce length of stay and minimize overnight admission rates, according to a new study.
Jestina Wolff, MSN, RN
While UFE is a minimally invasive procedure, there are pain management needs associated with it, and the nursing group at the Hospital of the University of Pennsylvania wanted to explore the best practices for managing pain in these patients.
“Having a background in surgical intensive care nursing, I recalled Enhanced Recovery After Surgery (ERAS) protocols were used to manage postoperative pain for many of the patients,” said Jestina Wolff, MSN, RN, lead author of The Effects of a Standardized Enhanced Recovery After Surgery (ERAS) Pain Management Protocol for Patients Undergoing a Uterine Fibroid Embolization (UFE), one of the SIR 2025 Featured Abstracts.
Wolff researched existing ERAS protocols targeting the gynecologic oncology population, which she and her team then used to inform the development of UFE protocols.
Using the Model for Healthcare Improvement, Wolff’s team employed the Plan-Do-Study-Act (PDSA) method to execute the new ERAS protocols, and reviewed pre- and posttest data.
Researchers found that by utilizing these new orders, they not only increased nursing practice standardization, but also standardized pain management medication orders. After implementing the protocols, intravenous opiate administration during recovery decreased, and overnight observation admissions went down.
“The ERAS-based pain management protocol has allowed a majority of UFE patients to be discharged home shortly after their procedure due to adequate pain management,” said Wolff. “This is a high patient satisfier and decreases the burden of 23-hour stays in the postanesthesia care unit.”
By reviewing these data, Wolff has also found areas for management improvement. For example, she has submitted an edit to their existing order set to allow for oral opiates to be administered to patients 1 hour prior to discharge, in the event they have not received any during their recovery period.
“With a majority of the patients being discharged home, we anticipate the transport to home to be uncomfortable and want to ensure that they are able to tolerate postoperative meds prior to leaving the department,” she said. “In addition, we are considering assessing the effects of starting bowel prophylaxis 1–2 days prior to a scheduled UFE. Constipation is a common complaint from these patients during their follow-up and can exacerbate post-procedure pain.”
By unifying pain management protocols and better examining the effects on patients, Wolff believes that patient satisfaction and overall care can be increased and advocates for other institutions to implement their own quality improvement projects.
Wolff will present her findings at SIR 2025 on Tuesday, April 1, at 3 p.m. during the Practice Development, Economics and Quality 2 session.
