The Effects of a Standardized Enhanced Recovery After Surgery (ERAS) Pain Management Protocol for Patients Undergoing a Uterine Fibroid Embolization (UFE)

Tuesday, April 1, 2025

3:09 PM – 3:18 PM CT

Location: Music City Center, 205 A

Presenting Author(s)

Jestina Wolff, MSN, RN (she/her/hers)

Nursing Professional Development
Hospital of the University of PA, United States

Author/Co-author(s)

CJ

Crystal Jackson, RN

RN
Hospital of the University of PA, United States
MM

Mary Ann Machristie, RN

RN
Hospital of the University of PA, United States
TU

Tanya Uritsky, PHARMD

Opioid Stewardship Coordinator
Hospital of the University of Pennsylvania, United States
TG

Troy Gibson, PHARMD

Pharmacy Informatics Manager
Hospital of the University of Pennsylvania, United States
Gregory J. Nadolski, MD

MD
Hospital of the University of PA, United States
RS

Richard D. Shlansky-Goldberg, MD, FSIR

Professor
Perelman School of Medicine/ Univ. of Pennsylvania, United States

Purpose: The aim of this quality improvement project was to unify pain management practices during the peri-procedural process and to determine the effects of implementing a standardized pain management pathway utilizing the principles of Enhanced Recovery After Surgery (ERAS) strategies in patients undergoing a uterine fibroid embolization (UFE).

Materials and Methods: ERAS protocols were used to create a novel order set to improve care standardization for patients undergoing UFEs. The study intervention employed a standardized multimodal order set associated with better pain management outcomes in gynecologic patients to facilitate consistent nursing care. Using the Model for Healthcare Improvement, the Plan-Do-Study-Act (PDSA) method was employed to execute the conceived UFE peri-procedural pain management process. A pre-post implementation study design evaluated nursing staff compliance with the new practice for a single interventional radiologist. Pre-test data was obtained via a 1-year retrospective study of performed UFEs. Post-test data collection occurred over a period of 6 months.

Results: The new order set significantly increased nursing practice standardization (P = 0.0001) and eliminated variation in pain management medication orders during the recovery phase of care. It also yielded a decrease in the volume of intravenous opiate administration in the recovery phase (P = 0.04; 95% CI), a reduction in the number of overnight observation admissions (P = 0.04), as well as a reduction in time spent in recovery prior to discharge (P = 0.01; 95% CI).

Nursing Practice Compliance

	Compliant	Non-Compliant	Total
Pre-Test	9	73	82
Post-Test	28	7	35
Total	37	80	117
Fisher's exact test - (P < 0.0001)

	Pre-Implementation Hydromorphone IV (mg)	Post-Implementation Hydromorphone IV (mg)
Mean	2.1	1.6
Median	2.0	1.5
T test - (P = 0.04; 95% CI)

	Same Day Discharge	ESSR	Total
Pre-Test	60	21	81
Post-Test	31	3	34
Total	91	24	115
Fisher's exact test - (P = 0.0456)

	Pre-Implementation Same Day Discharge Recovery Time in IR (H)	Post-Implementation Same Day Discharge Recovery Time in IR (H)
Median	4.66	4.25
Mean	4.67	4.26
T test - (P = 0.0169; 95% CI)

Conclusion: ERAS is a well-established surgical quality initiative that contributes to both clinical improvements and healthcare cost reduction. Results from the study show the use of an ERAS-based pain management order set for UFEs supports uniformity in nursing practice, decreased use of intravenous narcotics during the recovery phase, and reduced lengths of stay and overnight admission rates.