scholarly journals Improving Quality of Care via Effective Pain Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 895-895
Author(s):  
Jennifer Rose
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Pain Assessment ◽  
Nurse Managers ◽  
Assessment Tool ◽  
Emotional Reaction ◽  
Improvement Project ◽  
Pain Experience ◽  
Care Plans ◽  
Post Test

Abstract Pain is neither a vital sign nor a normal part of aging. Yet, older adults frequently experience pain chronically or from an acute event. Pain was identified as a gap per the Centers for Medicare & Medicaid Services Quality Measures report (2019). The purpose of this quality improvement project was to improve the assessment of pain at a skilled nursing facility (SNF) by using a standardized tool. The Comprehensive Pain Assessment Tool for the Cognitively Intact evaluates the complex sensation and emotional reaction of the pain experience. Nurse managers (N=7) received 1:1 education on pain, pain assessment, use of the pain assessment tool, and took a post-test. Chart audits were conducted to identify tool use and evaluate the patient response. Additional data were collected from nurse managers via a questionnaire. All nurse managers received education and completed the post-test. Pain assessments and care plans were completed for 100% of the SNF residents in the cohort (N=22). Follow-up assessments were completed on only 75% of the cohort. Of the cohort, 95% demonstrated improved physical ability and functioning in activities of daily living as their pain experience improved. Only 4.5% of the cohort participated in the anticipated level of minutes of therapy as a result of facility infection control limitations due to the COVID-19 pandemic. This project demonstrated improved pain management through use of a tool to comprehensively assess pain. An organizational policy to comprehensively assess pain at this SNF could promote a higher level of independence and functioning for older adults.

scholarly journals Improving the Quality of Care for Acute Pain Management in Recovery Room at the Georgetown Public Hospital Corporation

2019 ◽  
pp. 13-14
Author(s):  
Dorette Husbands-Anderson ◽  
Jennifer Szerb ◽  
Alexandra Harvey
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Standards Of Care ◽  
Average Dose ◽  
Management Intervention ◽  
Pain Medications ◽  
Post Operative Pain ◽  
Pain Intervention

Objectives: To observe the method of pain assessment and pain management intervention performed by nurses in the PACU. Methods and Design: A QI prospective observational study was conducted to observe nurse’s pain assessment and management of thirty (30) patients from the time of PACU admission to discharge. The sample size was determined using the sealed envelope power calculator. Data Collection Included: patients demographics, the method and frequency of pain assessments as well as modalities of the pain intervention and the type and average dose of pain medications administered by PACU nurses. Data analysis was done using Microsoft excel. Results: No validated pain assessment tool was used in the PACU.  The majority of patients 67%, n=20) had no pain assessments or pain interventions. When performed, the frequency of pain assessments recorded were low, 70% of patients had 1-2 assessments. The principal pain management intervention was pharmacological with the use of opioids, accounting for 96%. Conclusion: Post-operative pain management in the PACU at GPHC does not meet accepted standards of care. More frequent nursing pain assessment using a validated pain assessment tool is required. Monotherapy with the opioid was the main pain intervention for pain management. Recommendations: Effective pain management begins with the appropriate pain assessment; therefore pain management education programs for health care professionals are essential. Also, the implementation of a standardized pain assessment tool, a standardized post anesthetic order sheet with a multimodal approach to pain management and restructuring the post-anesthetic record to allow for documentation of pain assessment will greatly improve pain management in the PACU.

Pain Assessment and Management in Critically Ill Intubated Patients: a Retrospective Study

2004 ◽  
Vol 13 (2) ◽  
pp. 126-136 ◽  
Author(s):  
Céline Gélinas ◽  
Martine Fortier ◽  
Chantal Viens ◽  
Lise Fillion ◽  
Kathleen Puntillo
Keyword(s):  
Pain Management ◽  
Critically Ill ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Quebec City ◽  
Pharmacological Interventions ◽  
Relieve Pain ◽  
Self Reports ◽  
Data Collection Instrument ◽  
Pain Documentation

• Background Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally.• Objectives To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated.• Methods Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack’s theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients’ self-reports of pain) and observable/objective (physiological and behavioral) categories.• Results A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients’ self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time.• Conclusions Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

Adoption of a Pain Assessment Tool in Older Homebound Patients With Dementia in a Housecall Practice: A Dissemination Study

2012 ◽  
Vol 5 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Jean-Claude K. Provost
Keyword(s):  
Older Adults ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Selection Process ◽  
Pain Scale ◽  
Assessment Tools ◽  
Advanced Dementia ◽  
Pain Diagnosis

This article describes the steps of a pilot dissemination study toward adopting a pain assessment tool for older homebound adults with dementia. The chosen practice site had not previously used adequate pain assessment tools for older adults with dementia. After the selection process by a pain assessment tool committee, providers (N = 20) were asked to choose between three tools: pain assessment in advanced dementia (PAINAD), the Abbey Pain Scale, and DOLOPLUS-2/ DOLOSHORT. Providers voted to use the PAINAD (54%) for the following 2 weeks. A preintervention audit showed that without the use of a pain assessment tool, 97.7% of the charts did not have any documentation of a pain diagnosis nor an intervention. Postintervention using PAINAD, 91.3% of the charts had both (χ2[1] = 18.645, p < .001). The feedback obtained from providers (n = 10) after 2 weeks of testing the tool was unanimously positive. Many providers reported increased confidence in identifying pain and some changed their practice by placing pain assessment in the forefront of their encounter with their older clients with dementia. PAINAD was adopted as the pain assessment tool for this practice.

scholarly journals 147 Assessing Assessment: An Audit of Continence Assessment and Documentation in a City Centre Teaching Hospital

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Mary Randles ◽  
Mary Hayes ◽  
Susanne Cotter ◽  
Ines Saramago ◽  
Kieth McGrath ◽  
...  
Keyword(s):  
Older Adults ◽  
Assessment Tool ◽  
Geriatric Medicine ◽  
Hospital Setting ◽  
Mental Wellbeing ◽  
City Centre ◽  
Audit Tool ◽  
Care Plans ◽  
Continence Status

Abstract Background Urinary incontinence (UI) is defined by the International Continence Society as “any involuntary leakage of urine.” UI can negatively impact patients' physical and mental wellbeing and quality of life. Since older adults constitute a growing hospital population, evaluation and improvement of this patient group's quality of care is recognized as a priority in the study hospital. A continence assessment helps to determine what the problem is and what management is required. This audit aims to determine whether appropriate assessments of continence in older adults presenting to the hospital setting were completed and documented. Methods An audit tool was adapted from the Royal College of Physicians National Continence Audit tool and the hospital's own elimination documentation pathway. On a chosen day a general medical ward and a specialist geriatric medicine ward were assessed. Medical charts, nursing notes, emergency department proforma, frailty intervention team proforma and skin integrity proforma were reviewed. Documentation of continence status, symptoms, type, investigations, continence wear, catheterisation and management were assessed. Continence care plans and evidence of communication/discussion with patients were also assessed. Results Thirty-one sets of documentation were reviewed. Twenty-four patients were aged over 65. Of these patients 12 were male and 12 were female. Four patients had no continence status documented. Forty-two percent of those reviewed over 65 had documented incontinence and of these only 40% had the elimination section of their nursing proforma fully completed. Six of the patients with documented incontinence had their symptoms/type of incontinence documented. Two Patients had urinary catheters, the indications for these catheters were documented Conclusion This audit found that overall the assessment and documentation of continence in older adults was sub-optimal. Based on this audit an assessment tool and education program will be introduced to the specialist geriatric medicine ward with the goal of improving assessment of continence and optimal management.

scholarly journals Impact of applying brief educational program on nurses knowledge, attitude, and practices toward pain management

2015 ◽  
Vol 4 (2) ◽  
pp. 164 ◽  
Author(s):  
Shalabia El-Sayead Abozead ◽  
Mahmoud Al-Kalaldeh ◽  
Omar Al-Tarawneh
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Educational Program ◽  
Pain Education ◽  
Knowledge And Attitudes ◽  
Post Test ◽  
Knowledge And Attitude ◽  
Nurses Knowledge

<p><strong>Background:</strong> The role of pain education is well established in improving knowledge and attitude towards the adherence to pain assessment and management.</p><p><strong>Methods:</strong> A brief pain education program was delivered to assess nurses' knowledge and attitude towards pain assessment and management. The "KASRP" scale was used at three phases; pre, post, and three months' follow-up phases. Subsequent eight months observation on using pain assessment sheets was also performed.</p><p><strong>Results:</strong> One hundred and four nurses were assessed at the beginning, followed by 92 at the immediate post-test, and 70 at the follow-up. Although nurses scored lowest in having knowledge and attitudes prior to the program, a significant improvement was evident after delivering pain education. In addition, nurses' competency in pain assessment was maintained over the three months of assessment. Younger nurses with shorter clinical experience were found more reactive to the program than older nurses.</p><p><strong>Conclusions:</strong> A brief nurse-driven pain education has improved nurses' knowledge and attitude towards pain management.</p>

scholarly journals Frailty and Home Confinement during the COVID-19 Pandemic: Results of a Pre-Post Intervention, Single Arm, Prospective and Longitudinal Pilot Study

2021 ◽  
pp. 1-2
Author(s):  
C.P. Launay ◽  
L. Cooper-Brown ◽  
V. Ivensky ◽  
O. Beauchet
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
Social Care ◽  
Assessment Tool ◽  
Community Dwelling ◽  
Phone Call ◽  
Care Providers ◽  
Care Plans ◽  
Health And Social Care ◽  
Community Dwelling Older Adults

The COVID-19 pandemic had severe consequences for older adults. First, COVID-19 was associated with more severe medical complications and an increased mortality rate in older compared to younger adults (1). Second, home confinement, an intervention that reduces the spread of COVID-19, was associated with adverse consequences for the older community-dwelling population (2). It broke down social networks and the continuum of primary care, resulting in medication or food delivery issues, psychological fallout and increasing frailty risks (3). Frailty assessment provides insight into the degree of older community dwellers’ health status vulnerability, social isolation and adverse health event risks, and it should be assessed before interventions are proposed (3). We designed a short assessment tool known as “Evaluation SOcio-GERiatrique” (ESOGER) for Montreal’s homebound community-dwelling older adults (3). In a phone call, ESOGER briefly assessed frailty and social isolation and provided recommendations, facilitating contact with health or social care providers who initiate appropriate health and social care plans (3). This study aims to examine the longitudinal effects of ESOGER on frailty and social isolation in Montreal’s homebound community-dwelling older adults.

CRIES: A Neonatal Postoperative Pain Measurement Score

2018 ◽  
pp. 263-267
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Assessment ◽  
Reliable Method ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Neonatal Pain ◽  
Reliable Assessment ◽  
Assessment And Treatment ◽  
Neonatal Population

This case focuses on neonatal pain management by asking the question: Is the CRIES score a valid and reliable method for assessing neonatal postoperative pain? Regular pain assessment and treatment in the neonatal population are important postoperatively. The CRIES scale was designed to measure pain in the neonatal population, and this study demonstrated CRIES to be a valid and reliable assessment tool for identifying postsurgical pain in neonates. Multiple pain assessment tools, including CRIES, are available for use in neonatal patients and in patient populations who are otherwise unable to verbalize discomfort.

Improving Pain Management Knowledge Among Nurses

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pain Management ◽  
Pain Assessment ◽  
Quality Improvement Project ◽  
Project Implementation ◽  
Improvement Project ◽  
Emergency Department Nurses ◽  
Management Knowledge ◽  
Improve Patient

Pain is the most commonly presented symptom among patients who are admitted to the emergency department. Unfortunately, many barriers to pain management exist thereby impacting emergency department patient care and outcomes, specifically regarding inadequate pain assessment, reassessment, and documentation. Thus, the quality improvement project aimed to increase emergency department nurses knowledge of pain management and utilization of pain assessment guidelines, resources, and policies. By nurses having sufficient education, they can provide timely and efficient care to support patient outcomes, improve patient comfort, and improve patient satisfaction. The Knowledge and Attitudes Survey Regarding Pain was utilized to conduct a pre and post-test assessment to measure emergency department nurses’ knowledge of pain management [1]. The results of the quality improvement project showed that nurses lacked adequate pain management knowledge, 45.45% of participants responded incorrectly to knowledge questions about pain before the intervention. However, after the project implementation, the results of the data analysis showed a statistically significant mean increase of 23.91% from pre-intervention (65.65%) to post-intervention (89.56%) after eight weeks of project implementation. This quality improvement project will provide a basis for future studies in improving nurses’ pain management knowledge.

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