Pain management quality improvement at Howard University Hospital

Inpatient Pain management on surgical unit ( Quality improvement assignment).

Inpatient Pain management on surgical unit

The ultimate goal of pain management is to improve the patient's quality of life through increasing their daily function and diminishing the amount of chronic pain that is felt. Pain management services are usually provided by surgical units and the team involved in this process has to evaluate the pain and then treat it accordingly. The method used for pain management is determined by the surgical team at hand. Some of the pain syndromes that are treated include lower back pain, myofacial pain syndrome, cervical neck pain, cancer pain and headaches. In some institutions, pain management is a referral-based program which is mostly operated by the Department of Anesthesia. The services offered by the department include management of pain medication, injection of epidural steroids, therapeutic and diagnostic nerve blocks and lastly injection at trigger points Merskey, 1994()

Organization

The Howard University Hospital has an ongoing pain management improvement program. The hospital conducted a survey from March 2011 till February of 2012 and this survey also touched on the aspect of pain management. The survey results were compared to the result of a similar survey in the period from March 2010 till February of 2011. It was found that out of a total of 87 respondents, in the current survey (March 2011 till February of 2012) 61% felt that their pain was well controlled while in the hospital. This is compared to the 59% for the previous survey (March 2010 till February of 2011). On the question of whether the staff did everything to help with the pain, out of 88 respondents, 61% felt that the staff did everything they could to help. This is a drop when compared to the 67% of the previous year.

The data for the hospital survey is collected on a monthly basis and the benchmark for pain management as well as other aspects of the care is between 95-100%. The current data indicated that the total number of records under monitoring is 110 and the compliance rate is between 93-100% which is slightly below the desired benchmark. The reason why the hospital does take serious interest in monitoring this data is because they have a large volume of patients who come in requiring pain management services. The hospital management feels that pain management is a problem prone area since there are many patients who have complaints around this aspect of care.

From this data, we can see that the hospital does take interest in pain management as an area that needs improvement. The staff at the hospital is reminded that pain is the 5th vital signs and that whenever the level of pain is above 5, a pain assessment must be done and the appropriate management measures taken including administering medication.

Relevance to practice

Chronic pain is always complex in a multidimensional way. This includes the causes, effects to the body, tissues, body systems and the mind. Because of it being multidimensional, it cannot be adequately addressed by the use of a one-dimensional mode of treatment. Management of pain must extend beyond just the normal physical approaches. It must also incorporate psychological, spiritual and even social aspects of the patient. Effective pain management and treatment of pain is accomplished through encouraging self-awareness and teaching the appropriate, efficient and effective self-care to the patient. Through this, it is possible to ensure the pain is greatly reduced and that the patient moves forward in their life in terms of achieving physical and psychological functions Jason, Klapow, & Casebeer, 2000()

Therefore, all institutions involved in the provision of pain management services should be very specific and should incorporate quality improvement programs which will not only help to improve the quality of life for the patients but will also boost the image of the hospital to the general public as well increase revenues for the hospital Fordyce, 1994()

Implications for practice

Quality improvement, especially in the field of pain management is extremely important. Therefore, an individualized approach should be undertaken to the management of pain as shown in the available evidence from the review of literature. In a study conducted at the Penny George Institute for Health and Healing, Allina Hospitals & Clinics and Abbott Northwestern Hospital, it was found that when quality improvement measures were undertaken in pain management, the average reduction in the self-reported pain was about 1.9. This was on a scale of 0-10. Although we can see that the decrease in the pain score is quite significant, it is important to also remember that the initial levels of pain vary from one patient to another. Therefore, the percentage reduction in pain level is more important. The average percentage reduction for the patients in this study was 55.8% which goes to show that quality improvement in pain management is extremely important for all institutions Dusek et al., 2009()

Conclusion

Looking at the evidence provided by the literature and the studies analyzed, we can see that pain management is quite complex and it is multidimensional. Additionally, it is important for pain management to be done on an individual basis whereby each case or patient is looked at differently. It can also be seen that quality improvement in pain management brought a significant reduction in the pain levels of patients. Therefore, it is important that quality improvement measures should be undertaken for pain management.