scholarly journals Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

2012 ◽  
Vol 17 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Lisa M Zhu ◽  
Jennifer Stinson ◽  
Lori Palozzi ◽  
Kevin Weingarten ◽  
Mary-Ellen Hogan ◽  
...  
Keyword(s):  
Pain Management ◽  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Pain Assessment ◽  
Management Practices ◽  
Audit And Feedback ◽  
Opioid Administration ◽  
Pain Outcomes ◽  
Pain Prevalence ◽  
The Impact

BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.

Pain assessment, documentation, and management in a university hospital

2013 ◽  
Vol 4 (4) ◽  
pp. 256-257
Author(s):  
S. Zoёga ◽  
T. Aspelund ◽  
G. Sigurdsson ◽  
S.E. Ward ◽  
H. Sveinsdóttir ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
University Hospital ◽  
Medical Patients ◽  
Cross Sectional ◽  
Adequate Treatment ◽  
Pain Management Index ◽  
Pain Medications ◽  
Pain Prevalence

AbstractAimsTo determine if pain is assessed, documented, and treated in a university hospital according to recommended practice.MethodsA cross-sectional descriptive study, conducted in 23 medical and surgical wards in a university hospital. Participants were patients hospitalized for at least 24hours, ≥18 years of age, and able to participate. Data were collected from patients with a questionnaire (APS-POQ-R), from their medical records, and from Therapy®, the hospital medication system.ResultsThe response rate was 73%. Participants (N =308) mean age was 67.5 years (SD = 17.4), 50.5% were women. Pain prevalence in the past 24 h was 83.1% and severe pain was experienced by 34.5%. Descriptions of pain were documented for 60.7%. Standardized methods of assessment were used in 11.6% of patients, other forms of documentation included descriptions as “no pain-complaints”, and “patient received 2 Panodil”. The majority of patients (66.8%) were prescribed pain medications and 34.0% of patients used non-pharmacological methods to treat their pain. The pain management index (PMI = prescribed pain medication – worst pain severity) was negative for 38.6% indicating insufficient treatment. The PMI was more favorable in surgical compared to medical patients, x2(6, N = 306) = 17.81, p = 0.007.ConclusionsPain was both prevalent and severe. Although some form of documentation of pain was recorded for the majority of patients, pain was rarely assessed with standardized methods. Many patients did not receive adequate treatment. There is a need to improve the pain management practices in the hospital, with an initial emphasis on pain assessment.

scholarly journals Benchmarking Pain Outcomes for Children with Sickle Cell Disease Hospitalized in a Tertiary Referral Pediatric Hospital

2012 ◽  
Vol 17 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Abi Vijenthira ◽  
Jennifer Stinson ◽  
Jeremy Friedman ◽  
Lori Palozzi ◽  
Anna Taddio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Pain Intensity ◽  
Clinical Outcomes ◽  
Sickle Cell ◽  
Pain Assessment ◽  
Cell Disease ◽  
Process Outcomes ◽  
Pain Outcomes

BACKGROUND: Painful vaso-occlusive crisis (VOC) is the most common reason for hospitalization in children with sickle cell disease.OBJECTIVE: To benchmark pain outcomes in sickle cell disease, including process outcomes (eg, pain assessment and documentation practices, pain management interventions) and clinical outcomes (eg, pain intensity over hospital stay), to identify areas for improvement.METHODS: A retrospective study was conducted on electronic charts of children hospitalized with a primary diagnosis of VOC between July 2007 and August 2008.RESULTS: A convenience sample of 50 admissions was used. In terms of clinical outcomes, patients presented to the emergency department with an initial median pain intensity of 9/10 (interquartile range 8/10 to 10/10). Forty-three per cent had not used opioids for pain relief at home. The mean (± SD) length of stay was 4.0±2.3 days. For most patients, median scores for highest daily pain intensity remained moderate to high throughout hospitalization, although scores did decrease significantly per day of hospitalization. In terms of process outcomes, pain intensity was assessed according to hospital standards on 25% of days in both the emergency department and the ward. There was no discrepancy between prescribed and administered opioid doses and medication use. In 95% of cases, strong opioid use was in a subtherapeutic or low therapeutic dosage range.CONCLUSIONS: The results showed three areas to target for improvement: improved pain assessment and documentation using valid pain tools; more aggressive multimodal management for peak VOC pain; and better education and support for pain management at home. Further studies are required to evaluate optimal pain treatment practices.

Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis

2020 ◽  
Vol 68 (4) ◽  
pp. 888-892 ◽  
Author(s):  
Paige A Bishop ◽  
Carmen Isache ◽  
Yvette S McCarter ◽  
Carmen Smotherman ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Clinical Success ◽  
Audit And Feedback ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Usa ◽  
The Impact

Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

scholarly journals Barriers perceived by nurses in the optimal treatment of postoperative pain

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 239-246 ◽  
Author(s):  
Wioletta Medrzycka-Dabrowka ◽  
Sebastian Dąbrowski ◽  
Aleksandra Gutysz-Wojnicka ◽  
Aleksandra Gawroska-Krzemińska ◽  
Dorota Ozga
Keyword(s):  
Pain Management ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Management Practices ◽  
National Level ◽  
University Hospital ◽  
Municipal Hospital ◽  
Post Operative Pain ◽  
Polish Version ◽  
The University

AbstractIt is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses’ Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital.In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.

scholarly journals Interpreting the Meaning of Pain Severity Scores

2002 ◽  
Vol 7 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Marilyn J Hodgins
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Pain Measurement ◽  
Management Practices ◽  
Care Organization ◽  
Treatment Goals ◽  
Severity Scores ◽  
Measurement Tools ◽  
The Impact

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.

scholarly journals An Overview of Pain Management

2005 ◽  
Vol 91 (2) ◽  
pp. 20-30
Author(s):  
June L. Dahl
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Public Health Problem ◽  
The United States ◽  
Basic Knowledge ◽  
Rational Approach ◽  
Major Public Health Problem ◽  
Pharmacologic Treatments ◽  
Control Pain

ABSTRACT In spite of major advances in pain management practices, the undertreatment of pain remains a major public health problem in the United States. A basic knowledge of pain assessment and management is critical to removing the barriers that are responsible for poor pain control. Pain assessment is the essential first step in the management of any type of pain as it guides the development of a rational approach to treatment. Pharmacologic therapies are often essential to successful pain management. Three major classes of pain medications are available: non-opioids, opioids, and adjuvant analgesics for special pain problems. This paper provides an overview of the various drugs in each of these classes as well as recommendations to guide their use. The goal of therapy is to reduce pain and improve function. A comprehensive approach to pain management should be based on the use of multimodal therapy, rational combinations of pharmacologic and non-pharmacologic treatments.

scholarly journals Learning optimal opioid prescribing and monitoring: a simulation study of medical residents

JAMIA Open ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. 246-254 ◽  
Author(s):  
Thomas G Kannampallil ◽  
Robert McNutt ◽  
Suzanne Falck ◽  
William L Galanter ◽  
Dave Patterson ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Acute Pain ◽  
Management Practices ◽  
Longitudinal Design ◽  
Simulator Training ◽  
Appropriate Use ◽  
Long Acting ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Objective Hospitalized patients often receive opioids. There is a lack of consensus regarding evidence-based guidelines or training programs for effective management of pain in the hospital. We investigated the viability of using an Internet-based opioid dosing simulator to teach residents appropriate use of opioids to treat and manage acute pain. Materials and methods We used a prospective, longitudinal design to evaluate the effects of simulator training. In face-to-face didactic sessions, we taught 120 (108 internal medicine and 12 family medicine) residents principles of pain management and how to use the simulator. Each trainee completed 10 training and, subsequently, 5 testing trials on the simulator. For each trial, we collected medications, doses, routes and times of administration, pain scores, and a summary score. We used mixed-effects regression models to assess the impact of simulation training on simulation performance scores, variability in pain score trajectories, appropriate use of short- and long-acting opioids, and use of naloxone. Results Trainees completed 1582 simulation trials (M = 13.2, SD = 6.8), with sustained improvements in their simulated pain management practices. Over time, trainees improved their overall simulated pain management scores (b = 0.05, P &lt; .01), generated lower pain score trajectories with less variability (b = −0.02, P &lt; .01), switched more rapidly from short-acting to long-acting agents (b = −0.50, P &lt; .01), and used naloxone less often (b = −0.10, P &lt; .01). Discussion and conclusions Trainees translated their understanding of didactically presented principles of pain management to their performance on simulated patient cases. Simulation-based training presents an opportunity for improving opioid-based inpatient acute pain management.

PSXV-15 Application of a survey instrument for understanding pain management practices associated with equine assisted activities and therapy horses

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 358-358
Author(s):  
Carter Clark ◽  
Molly Nicodemus ◽  
Clay A Cavinder ◽  
Erdogan Memili ◽  
Katie Holtcamp ◽  
...  
Keyword(s):  
Pain Management ◽  
Management Practices ◽  
Cognitive Disorders ◽  
Survey Instrument ◽  
Vital Role ◽  
Document Management ◽  
Therapy Option ◽  
Human Participants ◽  
The Impact ◽  
Equine Assisted

Abstract Equine assisted activities and therapy (EAAT) is a popular therapy option for physical, psychological, and cognitive disorders. A critical component of this treatment option is the horse, and while research has reported the benefits for human participants, there is a lack of knowledge concerning the therapy horse due to limited research documenting the impact of these activities. Nevertheless, those that manage these animals understand the demanding activities placed on the therapy horse, and thus, can play a vital role in educating those new to the industry. Therefore, the objective of this study was to utilize a survey instrument to document management activities associated with pain for the therapy horse. An 11 forced-choice question survey was developed and sent out to 97 EAAT programs within the U.S. Participation was available online for a total of four months. Response rate was 31% (n = 30). From the respondents, 50% answered +46 yrs old for age, 70% answered +15 yrs equine experience, and 60% answered +11 yrs working in EAAT. The most popular answer for number of horses in the respondents’ EAAT program was &gt;11 horses (53%), and as to the horses in the program, 50% answered they had &gt;7 geriatric horses. The majority of the respondents answered “definitely yes” to having functionally lame horses used regularly in their programs (53%) and having experience with pain management practices associated with orthopedic (50%) and gastrointestinal (67%) conditions. The majority of the programs used vital sign measurements (67%), facial expressions (73%), and behavioral changes (87%) to detect equine pain. In conclusion, EAAT horses appear to commonly need healthcare practices for pain management suggesting further research is needed in precision medicine and animal welfare. In addition, educational programs covering pain management practices for individuals going into the EAAT industry would assist in ensuring the welfare of these animals.

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