1. Promoting Comfort and Pain Management on an Adult Acute Medicine Unit
Authors: S. Budd RN, S. Holmes-Walker PhD RN, D. Magiera RN, J. Bitoy RN,
J. Grunawalt MS, RN, GCNS-BC, W. Wood MSN, RN, ACNS-BC, S. Kendziora BSN, RN, 6B1 Staff, Robert Chang MD
“University of Michigan, Ann Arbor, MI
Purpose
Synthesis
Change
Implementation Strategies
Evaluation
Significance
The purpose of the project was to better understand factors
impacting our patients’ pain experience; implement patient and
nurse focused strategies for improving a patients comfort/pain
management; and to improve the units patient pain satisfaction
scores attained after discharge.
Over the past few decades increased emphasis has been
directed on patients perception and relief of pain during
hospitalization. Governing and accrediting bodies over health
care institutions survey and address many aspects of a patients
hospitalization and the care they received. One of the many
areas include the patients perception and relief of pain during
the hospitalization1,2. Poor pain control, during hospitalization,
has untoward outcomes to not only patients but also to hospitals
at large. Unrelieved pain can contribute to physiological and
emotional distress, decreased quality of life, increased
readmission rates, increased lengths of stay, and lower
reimbursement rates2,3.
Although patient education is required in training an continuing
education of health care professionals, a number of gaps
remain in the quality and safety of pain management provided to
patients. These include; health care professionals knowledge
and perceptions regarding pain management, communication
amongst providers and patients, setting achievable pain/comfort
goals, and patient education. To achieve a goal of better
pain/comfort management and patient satisfaction, healthcare
professionals must close the gaps and ensure patients are
active partners in their pain/comfort management plan.
We began by gathering data regarding patients pain history and pain experience while admitted and found that 84% (n=49) stated they
had chronic or persistent pain and 78% were taking pain medication for pain prior to hospitalization.
Nurses on the unit were given the “Knowledge & Attitudes Survey Regarding Pain”4 to evaluate their perceptions regarding pain
management. The results from the survey (n=25) were that 68% answered the questions correctly and 72% felt their ability to care for
patients with chronic pain was good/very good. Education was provided to nursing staff regarding quality pain management to dispel any
myths about managing patients with chronic pain and complex medical diagnoses.
A Comfort Menu (CM), listing available non-pharmacological items to promote comfort, was developed and given to patients on
admission. The nurse was responsible for explaining the use and purpose of the menu. Audits were performed to ensure compliance in
distributing and explaining the CM to patients. Results from the audits we found the CM was appropriately distributed 91.3% of the time.
Emails were sent to nurses to remind them of the importance of managing patient’s comfort/pain.
Feedback was collected from patients to assess if the CM was beneficial to this population. Patients were surveyed of the responses:
“Was the Comfort Menu a valuable resource” (n=81) Yes=91% No=2% and I have/will use the “Comfort Menu” (n=83) Yes=90% N0=4%
In September 2014 Press Ganey patient satisfaction pain
scores on 6B, an Internal Medicine Unit, were well below
University of Michigan Health System (UMHS) standards. A
team of nurses on the unit conducted a quality improvement
(QI) project to assess the knowledge and attitude regarding pain
for nurses on the unit and address comfort/ pain management
for patients on the unit.
Patient discharge card questionnaire responses January 2015-August 2015 (n=263):
“Were you included in the management of your pain/comfort plan of care while you were hospitalized?” 98% responded yes
“Was your pain/comfort managed to meet your needs?” 96% responded yes
According to the literature, there is increased emphasis on utilizing a
multimodal approach for pain management(3). This unit utilized assessing
staffs knowledge and perceptions regarding pain, providing staff education,
and partnering with patients in the management of their pain/comfort.
According to the responses from the discharge questionnaire, these
combined interventions have made a positive impact on patients
pain/comfort experience. Although the Press Ganey data is highly variable,
there has also been significant and continual improvement in units patient
satisfaction scores related to pain control. This project could be readily be
applied to other units in the inpatient setting.
References
1. Gupta, A., Daigle, S., Mojica, J & Hurley, R. (2009). Patient perception of pain care in hospitals in the United States. Journal of Pain
Research, 2, 157-164.
2. Jarrett, A., Fancher-Gonzalez, K., Lofton, A. (2013). Nurses’ Knowledge and Attitudes About Pain in Hospitalized Patients. Clinical
Nurse Specialist 27(2):81-7
3. Polomano, R. C., Dunwoody, C. J., Krenzischek, D. A. (2008). Perspective on Pain Management in the 21st Century. Pain
Management Nursing, 9 (1) S3-S10.
4. Knowledge and Attitudes Survey Regarding Pain” developed by Betty Ferrell, RN, PhD, FAAN and Margo McCaffery, RN,MS, FAAN,
(http://prc.coh.org), revised 2008
5. Schreiber, J. A., Cantrell, D., Moe, K. A., Jeanine, H., McKinney., Lewis, P. C., Weir, A. (20014). Improving Knowledge, Assessment,
and Attitudes Related to Pain management: Evaluation of an Intervention. Pain Management Nursing 15 (2) 474-481.
6. “Arnstein, P. (2010). Clinical coach for effective pain management, F.A. Davis: Philadelphia.
82.8
81.4
83.3
82.3 82.6
81.5 81.2 80.9 80.9
83.0 83.2
85.2
75.0
66.7
93.8
75.0
90.0
78.9
86.1
82.1
87.5
95.0
81.3
87.5
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
95.0
100.0
Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
UH 6B1 "How Well Your Pain Was Controlled"
12 Month Moving Average vs. Monthly Mean Score
(Press Ganey)
12 month average
Monthly Mean Score
Linear (Monthly
Mean Score)From September 2014 until July 2015 the 12month mean score
increased from 81.4 to 85.2 (3.8 points).