Pain management—Continuum of care for surgical patients - Home Study Program

AORN Journal, Sept, 2003 by Sharon W. Chavis, Linda H. Duncan

OUTCOME SUMMARY

Many goals were achieved, as is demonstrated by positive measurable outcomes. Success was the direct result of collaboration between two hospitals to improve and standardize care. Nursing staff members, anesthesia care providers, and surgeons all were included in this collaboration. As reflected in the chart audit, documentation has improved significantly, demonstrating 92% to 100% improvement in all elements measured as of October 2002 with only one exception. The issue of ensuring documentation of patients' pain rating in the PACU using appropriate scales at one facility is being addressed. Reevaluation with chart audits is scheduled to occur in 2003.

The continuum of care delivered has improved as has communication between the facilities, departments, and health care team members, which has enhanced pain management for surgical patients. Staff members have been extremely supportive of the changes implemented. Their eagerness to learn and build a strong knowledge base for pain management and related pharmaceutical issues was reflected in staff members' compliance with attending pain management education sessions. Patient and family member educational material and tool enhancements also have been fully implemented. Team members plan to monitor patient satisfaction survey scores as a measure of success for many of the strategies implemented. For example, patients have the opportunity to rate facilities on how well they feel their pain was controlled.

Physician education also has been critical in the success of team members' goals. Staff members at both hospitals have become stronger patient advocates and encourage anesthesia care providers and surgeons to provide orders in keeping with recommendations from the pharmacy. Both anesthesia groups were educated on and requested to use the new physician standing orders and protocols form. The orders now are used on 100% of the records of patients routing through the PACU at V BH and 96% of patient records at LCH. The orders have facilitated staff members' ability to intervene and respond in a more timely manner to patients' requests and needs for pain management in the PACU and the surgery centers. An additional benefit gained was the collaboration of the separate anesthesia groups from each hospital in support of a PT team. This joint effort may open doors to future improvement efforts.

Team members will continue to meet on a quarterly basis to monitor and measure future outcomes. The surgical services division has identified this team as one of the most successful regarding process for PI efforts. In addition, the Centra Health pain council is using the PI team as the model to help start initiatives in other service areas.

Members of the PI team identified and chartered a course to improve pain management for surgical patients. The surgical services division realized that successful pain management was more than just complying with JCAHOs' standards for pain management. Though the Commission's standards are required, surgical services staff members acted on the desire to do the right thing and make a significant difference in patient care delivery and outcomes.