Improving Documentation of Pain Management at MedStar Washington Cancer Institute

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain

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

American Journal of Critical Care ◽

10.4037/ajcc2004.13.2.126 ◽

2004 ◽

Vol 13 (2) ◽

pp. 126-136 ◽

Cited By ~ 112

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.

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Volunteers as Facilitators of Communication About Pain

Research on Aging ◽

10.1177/0164027511426879 ◽

2011 ◽

Vol 34 (2) ◽

pp. 246-253 ◽

Cited By ~ 5

Author(s):

Elaine Wittenberg-Lyles ◽

George Demiris ◽

Betty Ferrell ◽

Sara Shaunfield

Keyword(s):

Pain Management ◽

Family Caregivers ◽

Administrative Support ◽

Pilot Project ◽

Future Research ◽

Positive Experience ◽

Staff Members ◽

Hospice Volunteers ◽

Need Support ◽

Care At Home

Often unskilled for the hospice caregiving role, family members who provide patient care at home need support to facilitate pain management. Volunteers who serve as members of the hospice team may be able to complement staff efforts to discuss pain with caregivers. A pilot project was developed to determine if volunteers could be trained to facilitate communication about pain with family caregivers. Two hospice volunteers were trained and three family caregivers received the intervention in their homes. Caregivers and volunteers were interviewed about the experience. Both caregivers and volunteers reported a rewarding and positive experience. Caregivers prioritized the need to talk with someone, and volunteers preferred working with caregivers instead of administrative support duties. Volunteers could be trained to deliver the intervention material, but information from volunteer visits was not immediately reported to hospice staff members. Future research should assess the benefits of using hospice volunteers to support clinical efforts.

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Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

10.32920/14638998 ◽

2021 ◽

Author(s):

Tricia Kavanagh ◽

Bonniue Stevens ◽

Kate Seers ◽

Souraya Sidani ◽

Judy Watt-Watson

Keyword(s):

Pain Management ◽

Appreciative Inquiry ◽

Action Plan ◽

Implementation Process ◽

Study Data ◽

Pediatric Care ◽

Clinical Issue ◽

Staff Members

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study.

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Postoperative pain documentation in a hospital setting: A topical review

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.12.010 ◽

2016 ◽

Vol 11 (1) ◽

pp. 77-89 ◽

Cited By ~ 6

Author(s):

Kristiina Heikkilä ◽

Laura-Maria Peltonen ◽

Sanna Salanterä

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Hospital Setting ◽

Postoperative Pain Management ◽

Assessment Tools ◽

Cochrane Library ◽

Topical Review ◽

Pain Documentation

AbstractBackground and aimsNursing documentation supports continuity of care and provides important means of communication among clinicians. The aim of this topical review was to evaluate the published empirical studies on postoperative pain documentation in a hospital setting.MethodsThe review was conducted through a systematic search of electronic databases: Web of Science, PubMed/Medline, CINAHL, Embase, Ovid/Medline, Scopus and Cochrane Library. Ten studies were included. Study designs, documented postoperative pain information, quality of pain documentation, reported quality of postoperative pain management and documentation, and suggestions for future research and practice improvements were extracted from the studies.ResultsThe most commonly used study design was a descriptive retrospective patient record review. The most commonly reported types of information were pain assessment, use of pain assessment tools, useof pain management interventions, reassessment, types of analgesics used, demographic information and pain intensity. All ten studies reported that the quality of postoperative pain documentation does not meet acceptable standards and that there is a need for improvement. The studies found that organization of regular pain management education for nurses is important for the future.ConclusionsPostoperative pain documentation needs to beimproved. Regular educational programmes and development of monitoring systems for systematic evaluation of pain documentation are needed. Guidelines and recommendations should be based on the latest research evidence, and systematically implemented into practice.ImplicationsComprehensive auditing tools for evaluation of pain documentation can make quality assessment easier and coherent. Specific and clear documentation guidelines are needed and existing guidelines should be better implemented into practice. There is a need to increase nurses’ knowledge of postoperative pain management, assessment and documentation. Studies evaluating effectiveness of high quality pain documentation are required.

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Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

10.32920/14638998.v1 ◽

2021 ◽

Author(s):

Tricia Kavanagh ◽

Bonniue Stevens ◽

Kate Seers ◽

Souraya Sidani ◽

Judy Watt-Watson

Keyword(s):

Pain Management ◽

Appreciative Inquiry ◽

Action Plan ◽

Implementation Process ◽

Study Data ◽

Pediatric Care ◽

Clinical Issue ◽

Staff Members

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study.

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Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.06.006 ◽

2016 ◽

Vol 13 (1) ◽

pp. 32-35 ◽

Cited By ~ 5

Author(s):

Lars Sturesson ◽

Ann-Charlotte Falk ◽

Maaret Castrén ◽

Leila Niemi-Murola ◽

Veronica Lindström

Keyword(s):

Emergency Department ◽

Pain Management ◽

Pain Intensity ◽

Intervention Group ◽

Musculoskeletal Injuries ◽

Post Intervention ◽

Patients Satisfaction ◽

Increased Risk ◽

Significant Difference ◽

Pain Documentation

AbstractBackgroundPain is one of the most common symptoms treated in emergency department (ED). Pain may cause suffering and disability for the patient. Inadequate pain management may be associated with increased risk of complications such as sleep disturbance, delirium and depression. Previous studies conclude that pain management in ED is insufficient and inadequate. Yet, little is known about patients’ own experience regarding pain management in ED.ObjectiveThe aim of this study was to explore the satisfaction of pain management in patients having acute musculoskeletal injuries before and after implementation of mandatory documentation regarding pain assessment in the ED.MethodAn observational pre-post intervention study design was used. The study was conducted on patients having acute musculoskeletal injuries such as soft tissue injury, back pain or wrist/arm/leg/foot fractures in a 24-h adult (>15 years) ED at a public urban teaching hospital in Stockholm, Sweden. Data was collected by an interview based on a questionnaire.ResultsA total of 160 patients answered the questionnaire. In the pre- (n = 80) and post-intervention (n = 80) groups, 91/95% experienced pain in the ED. A significant difference (p < 0.003) was found during the post-intervention period, with more patients receiving analgesics compared to the pre-intervention group. A significant decline (p < 0.03) in patients’ own reported pain intensity at discharge was found between the groups. Patients’ reported satisfaction on pain management in the ED increased in the post-intervention group, but the difference was not statistically significantly.ConclusionPatients’ satisfaction with pain management increased, but not statistically significantly. However, both percentages of patients receiving analgesic drugs increased and pain intensity decrease at discharge were statistically significant after the intervention that made nurses obliged to register pain.Implication According to the findings of this study, mandatory pain documentation facilitates pain management in the ED, but there is still room for improvement. Additional actions are needed to improve patients’ satisfaction on pain management in the ED. Mandatory pain documentation in combination with person-centred care could be a way of improving patients’ satisfaction on pain management. Effective pain management is an important quality measure, and should be focused on in acute care in the ED. By routinely asking patients to report the pain intensity at discharge, the ED personnel can have direct feedback about the factual pain management. RNs may also be encouraged to use intravenous analgesics in higher extent when the patients have very severe pain.

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The consolidation of microscopy technology into a university research support facility: Reflections on the 1980's and projections for the 1990's at the university of iowa

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100148216 ◽

1993 ◽

Vol 51 ◽

pp. 476-477

Author(s):

Kenneth C. Moore

Keyword(s):

Laser Scanning ◽

Freeze Fracture ◽

Freeze Substitution ◽

Research Support ◽

University Of Iowa ◽

Staff Members ◽

The Past ◽

Research Grade ◽

The University ◽

Support Facility

The University of Iowa Central Electron Microscopy Research Facility(CEMRF) was established in 1981 to support all faculty, staff and students needing this technology. Initially the CEMRF was operated with one TEM, one SEM, three staff members and supported about 30 projects a year. During the past twelve years, the facility has replaced all instrumentation pre-dating 1981, and now includes 2 TEM's, 2 SEM's, 2 EDS systems, cryo-transfer specimen holders for both TEM and SEM, 2 parafin microtomes, 4 ultamicrotomes including cryoultramicrotomy, a Laser Scanning Confocal microscope, a research grade light microscope, an Ion Mill, film and print processing equipment, a rapid cryo-freezer, freeze substitution apparatus, a freeze-fracture/etching system, vacuum evaporators, sputter coaters, a plasma asher, and is currently evaluating scanning probe microscopes for acquisition. The facility presently consists of 10 staff members and supports over 150 projects annually from 44 departments in 5 Colleges and 10 industrial laboratories. One of the unique strengths of the CEMRF is that both Biomedical and Physical scientists use the facility.

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Communication Disordered: Program Implementation in Long-Term Care

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig15.64 ◽

2016 ◽

Vol 1 (15) ◽

pp. 64-67

Author(s):

George Barnes ◽

Joseph Salemi

Keyword(s):

Program Implementation ◽

Long Term Care ◽

Family Satisfaction ◽

Regulatory Compliance ◽

Care Staff ◽

Term Care ◽

Staff Members ◽

Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

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The real cost of pain management

Anaesthesia ◽

10.1046/j.1365-2044.2001.02367.x ◽

2001 ◽

Vol 56 (11) ◽

pp. 1031-1033 ◽

Cited By ~ 8

Author(s):

C. J. Phillips

Keyword(s):

Pain Management ◽

The Real ◽

Real Cost

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