{"id":302,"date":"2024-11-06T15:34:27","date_gmt":"2024-11-06T15:34:27","guid":{"rendered":"https:\/\/iims.uthscsa.edu\/isrn\/?page_id=302"},"modified":"2024-11-06T15:34:27","modified_gmt":"2024-11-06T15:34:27","slug":"kaiser-permanente-painscape-taking-pain-management-beyond-the-5th-vital-sign","status":"publish","type":"page","link":"https:\/\/iims.uthscsa.edu\/isrn\/resources\/ereading-room\/abstracts\/kaiser-permanente-painscape-taking-pain-management-beyond-the-5th-vital-sign\/","title":{"rendered":"Kaiser Permanente Painscape: Taking Pain Management Beyond the 5th Vital Sign"},"content":{"rendered":"

[vc_row][vc_column width=”2\/3″][vc_column_text css=””]<\/p>\n\n\n\n\n\n
Primary Author:<\/td>\nWilliam Scott Heisler, MBA, RN<\/td>\n<\/tr>\n
Co-Principal Investigators\/Collaborators:<\/td>\nChristi Zuber<\/td>\n<\/tr>\n
Organization:<\/td>\nKaiser Permanente<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Abstract<\/h2>\n

Background<\/h3>\n

Approximately 50% of the post-operative patients report having received adequate pain relief during the course of their recovery1*<\/sup>. 1,2,3<\/sup> The Joint Commission required hospitals to standardize practices around appropriate pain assessment and the management of pain using a scale for measurement (ie 0 \u2013 10 scale).4<\/sup><\/p>\n

Purpose<\/h3>\n

Managing pain still remains challenging in a clinical setting.3,5,6 <\/sup><\/p>\n

Materials & Methods<\/h3>\n

Better nursing communications needed.7, 8<\/sup> Better collaboration amongst clinicians, patients and family to manage post-surgical pain.9<\/sup><\/p>\n

Practice Change<\/h3>\n

Individual Nursing Practice; Focused preparation before room visit; Probe Patient\u2019s Pain, considering functional goals and ADLS; Most appropriate dose for initial transition to PO Pain Medications; Reassess the patient timely.<\/p>\n

Team Nursing Practice<\/h3>\n

Encourage around the clock dosing even if PRN is ordered; Cross-shift support to keep pain regimen going at night.<\/p>\n

Evaluation<\/h3>\n

Improved patient comfort; nurse\u2019s understanding ways to provide pain management; Non-RN Clinical staff evaluation of nursing skill around pain management; Patient informed about pain management.<\/p>\n

Results<\/h3>\n

Decrease in patient\u2019s pain variance2*<\/sup> of 23% on one pilot unit; Nurses showed better understanding of patients needs for pain management (+44%) and improved collaboration with patients (+25%); Non RN Clinicians ratings: Nurse\u2019s Effectiveness (+27); Nurse\u2019 Safer (+13%); Job Easier (+15%); Patients more informed (+19%).<\/p>\n

Conclusion<\/h3>\n

KP Painscape tested on medical units as well.<\/p>\n

Lessons Learned<\/h3>\n

Departments with a pain variance of greater than 1 have more opportunity for improvement. There seems to be a \u201csweet spot\u201d between .5 and 1 as a range for optimal pain variance<\/p>\n

1* Pain variance is the difference between the patient\u2019s stated pain score and their acceptable pain level when a 1 \u2013 10 scale is used. Results cited represent one unit for average pain variance between 5am and 9am.<\/p>\n

2* 23 million in a 1992 report and 16.1 million in a 2004 report. Both state 50% or more getting inadequate pain relief.<\/p>\n

Bibliography<\/h2>\n
    \n
  1. http:\/\/www.ahrq.gov\/clinic\/medtep\/acute.htm#acuteintro<\/a><\/li>\n
  2. Patient Safety and Quality \u2013 An Evidence-Based Handbook for Nurses, Chapter 17.Edited by Ronda G. Hughes. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2008. Publication No.:08-0043. p. 2<\/li>\n
  3. McCaffery M. Pain management; problems and Progress. In: McCaffery M, Pasero C. Pain: clinical Manual. 2nd ed. St. Louis, MO: Mosby; 1999. p. 1 – 14<\/li>\n
  4. JCAHO. Comprehensive hospital accreditation Manual. Oakbrook Terrace, IL, 2001.<\/li>\n
  5. Apfelbaum JL, Chen C, Mehta S, et al. Postoperative pain experience: results from a national survey suggesting postoperative pain continues to be undermanaged. Anesth Analg 203:97:534-40<\/li>\n
  6. Hutchinson RW. Challenges in acute post operative pain management. Am J Health Systm Pharm 2007; 64(6 Suppl): S2- S5.<\/li>\n
  7. Gittell JH, Fairfield K, Bierbaum B, et al. Impact of Relational coordination on quality of care, postoperative Pain and functioning, and length of stay: A nine-hospital study of surgical patients. Med Care. 2002; 38 (8):807-819.<\/li>\n
  8. Horsley J, Crane J, Reynolds MA. Pain: DeliberativeNursing interventions. New York: Grune & Stratton, 1982<\/li>\n
  9. Car DR, Jacox AK, Chapman CR, et al. Acute pain Management: Operative or medical procedures and Trauma, No. 1. Rockville, MD: AHCPR pub. No. 920032; Public Health Service; U.S. Dept. of Health and Human Services, 1992.<\/li>\n<\/ol>\n

    \u00a9 Improvement Science Research Network, 2011[\/vc_column_text][\/vc_column][vc_column width=”1\/3″]