Improving pain treatment for burn unit patients

For patients hospitalized with severe burns, treatment often requires daily visits to the tub room for wounds to be cleaned and debrided. The pain can be extreme.

“It’s a pretty intense time of the day for the patient,” said Laura Madsen, a nurse with the UCHealth University of Colorado Hospital Burn Center. “Pain, but a lot of anxiety as well.”

The opioids and benzodiazepines traditionally used to treat pain can lead to over-sedation, physical dependence and breathing problems. Madsen and fellow burn center nurse Jill Rozynski both led projects introducing alternatives as safe and effective solutions to pain and anxiety during wound care.

Rozynski’s project researched oral ketamine. It is safer to administer, relieves pain, calms patients, and they’re able to remain conscious enough to participate in their care. She worked with a multidisciplinary group of colleagues to implement this alternative at the burn center. The outcome was a 33% reduction in opioids used, 38.8% improvement in mean pain scores, 36.6% reduction in patient anxiety and 37.5% improvement in overall patient experience.

“It helps them relax overall, and they feel in control, comfortable and a part of their care,” she said.

For some patients, ketamine can cause strange hallucinations and dreams, as well as high blood pressure. Madsen’s project examined the use of sublingual dexmedetomidine, which has similar sedative effects to ketamine but is more likely to lower blood pressure. And hallucinations are less likely.

For the patients who received dexmedetomidine, average pain scores decreased by 32%, and the maximum pain score on average fell 39%. The intravenous use of fentanyl decreased 23% and midazolam decreased 38%.

“We are excited for these outcomes and continue to evaluate the medications, having added them to our playbook of options for our patients’ wound care medication regimen,” said Jenn Wilson, nurse manager with the burn center. “Both Laura and Jill exemplify patient-centered care and epitomize what it means to be a burn nurse through their exceptional work and advocacy for our patients.”

Rozynski presented her work to a national audience last year at the annual American Burn Association meeting, and her project’s findings were published in the ensuing edition of the Journal of Burn Care and Research. Rozynski became a Nightingale Luminary award recipient and was awarded the UCH Magnet Nurse of the Year award.

Madsen, now in an ICU RN role, previously served as the burn center’s outreach program manager, partnering with fire department professionals to lead community education events; provide clinical education to other hospitals, providers and EMS; and fundraise to provide resources to burn survivors and families. A Survivors Offering Assistance in Recovery (SOAR) trainer and coordinator, Madsen also organized a trip to Crested Butte for survivors, families and staff in partnership with the Washington, D.C. Firefighter’s Charitable Foundation.