Breakthrough pain assessment and management among adult patients in an orthopedic ward: a best practice implementation project

JBI Evid Implement. 2026 Jun 22. doi: 10.1097/XEB.0000000000000608. Online ahead of print.

ABSTRACT

INTRODUCTION: The proportion of orthopedic patients experiencing breakthrough pain (BTP) is as high as 82.5%, which can result in fear and activity avoidance in patients, thereby hindering recovery.

OBJECTIVE: This project aimed to promote evidence-based practices for the assessment and management of BTP in orthopedic patients.

METHODS: This project was guided by JBI Evidence Implementation Framework. We conducted an evidence-based practice project to assess and manage BTP in the orthopedic department of a tertiary hospital in China. The project adopted an audit and feedback approach across seven distinct phases. Ten audit criteria were developed for baseline and follow-up audits to assess program effectiveness. The project also used the JBI Practical Application of Clinical Evidence System (JBI PACES) and the JBI Getting Research into Practice (GRiP) method for implementation.

RESULTS: At baseline, only one criterion-routine pain screening using the Numeric Rating Scale within 8 hours of admission-met the best practice standard. The other nine criteria showed deficiencies. The research team analyzed the gaps and identified six barriers based on these results. Strategies to address these barriers were designed and implemented. In follow-up audit 1, the compliance rates improved for all but Criterion 1. In follow-up audit 2, the compliance rates decreased to varying degrees for all but Criterion 1 compared with the first follow-up audit. In both follow-up audits, the frequency of BTP was significantly reduced compared to the baseline audit (p < 0.05).

CONCLUSION: Using evidence-based strategies guided by the JBI Evidence Implementation Framework, this project improved compliance with pain assessment practices and reduced BTP episodes among orthopedic patients.

SPANISH ABSTRACT: http://links.lww.com/IJEBH/A599.

PMID:42319034 | DOI:10.1097/XEB.0000000000000608