{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:40:15Z","timestamp":1787730015335,"version":"build-2784847793"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,3]],"date-time":"2018-10-03T00:00:00Z","timestamp":1538524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Regular, routine, multimodal analgesia provides better pain relief following Caesarean section than reliance on \u201cas required\u201d opiate dosing. This quality improvement report describes the effective use of an education programme coupled with a highlighted, preprinted medication chart, employing \u201cNudge Theory\u201d principles to achieve significant improvements in the administration of analgesic medications to patients after Caesarean section operations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Problem<\/jats:title><jats:p>An acute pain service audit identified a serious deficiency with delivery of regular postoperative analgesic medications to patients following Caesarean section operations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An audit of pain medication delivery to patients following Caesarean section demonstrated that postoperative analgesia was not being administered in line with local prescribing guidelines. Two interventions were planned:\n<jats:list>\n<jats:list-item><jats:p>Education sessions for anaesthetic recovery and ward staff.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Introduction of a new preprinted and highlighted medication chart.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p>A postintervention audit was then conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were statistically significant improvements in all medications administered to patients following the two interventions. For analgesic medications, the rate of administration of drugs in compliance with guidelines rose from 39.6% to 89.9% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001 using 2\u2010sample <jats:italic>z<\/jats:italic> test). Each subgroup of medications also showed statistically significant improvements in administration compliance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A combined approach, including application of \u201cNudge Theory\u201d to the administration of analgesic medication after Caesarean section, considerably improved delivery of medications prescribed for postoperative analgesia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13037","type":"journal-article","created":{"date-parts":[[2018,10,5]],"date-time":"2018-10-05T14:19:28Z","timestamp":1538749168000},"page":"125-129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Successful use of \u201cChoice Architecture\u201d and \u201cNudge Theory\u201d in a quality improvement initiative of analgesia administration after Caesarean section"],"prefix":"10.1111","volume":"25","author":[{"given":"Tim","family":"Shakespeare","sequence":"first","affiliation":[{"name":"Anaesthesia, Perioperative and Pain Medicine University Hospital Geelong  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Fehlberg","sequence":"additional","affiliation":[{"name":"Anaesthesia, Perioperative and Pain Medicine University Hospital Geelong  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Slejko","sequence":"additional","affiliation":[{"name":"Epworth Hospital  Geelong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Taylor","sequence":"additional","affiliation":[{"name":"Departments of Pharmacy University Hospital Geelong  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Srbinovska","sequence":"additional","affiliation":[{"name":"Anaesthesia, Perioperative and Pain Medicine University Hospital Geelong  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8170-0345","authenticated-orcid":false,"given":"Stephen","family":"Bolsin","sequence":"additional","affiliation":[{"name":"Anaesthesia, Perioperative and Pain Medicine University Hospital Geelong  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,3]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Consultative council on obstetric & paediatric mortality & morbidity. 2010\u20102011 Victoria's mothers and babies; Victoria's maternal perinatal Child and Adolescent Mortality2014."},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2009.03.013"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2006.12.001"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1997.243-az0378.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzg085"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq131"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex072"},{"key":"e_1_2_5_9_1","first-page":"p89","volume-title":"Nudge: Improving Decisions About Health, Wealth & Happiness","author":"Thaler RH","year":"2008"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005473"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1057\/9780230612044_1"},{"key":"e_1_2_5_12_1","unstructured":"National Health & Medical Research Council (NH&MRC) Australian Research Council Australian Vice\u2010Chancellors Committee. 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