Table 1 An overview of the intervention and implementation

Admission interview with the patient/RN regarding pain.

The novel routine: The RN obtained the patient’s narrative at the pre-admission visit, including information regarding everyday life and the impact of pain prior to the planned surgery. The narrative was summarized in a care plan, with other clinical information. A tentative PCC plan was written by the RN, including the patient’s recovery goal and expected length of stay. The PCC plan was finalized and updated the evening before planned surgery when the patient was admitted.

Two workshops in autumn 2018 and one in February 2019 were held with RNs in the outpatient clinic, hosted by RN expert in PCC. As new RNs started in the clinic, they received information and training in PCC and documenting patients’ narratives.

Care plan with focus on pain and pain management.

The novel routine: Continuous documentation of pain and pain management in the care plan following the guideline. All staff were able to use the plan.

A flowchart to use as a guideline was developed by the RNs in the expert group. RNs in the outpatient clinic and the ward were informed of the use of the care plan, starting in February 2019.

Round routine with explicit roles.

The novel routine: Checklist and precise timings for the round. All professions to be present at the round. MD to lead the round according to checklist; RN to document a summary in the care plan.

As all professions were represented in the expert group, relevant professional issues regarding the round emerged in discussions. Professional differences of opinion mostly concerned the timing and the importance of the round. A routine was established by consensus after multiple sessions, and then agreed with relevant first line managers before starting in October 2018.

Written patient discharge summaries.

The novel routine: Ward secretaries were assigned to add the template to patients’ journals, and the physician at discharge was responsible for adjusting it to the patient.

Routines for templates were established. Started in November 2018.