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Tuesday, 30 January 2007 - 1:45 PM
Sustained Quality Improvement Related to Pain Cycle Documentation
Objectives:
Analysis of second quarter 2005 NDNQI pain AIR cycle documentation showed an opportunity for improvement on a medical-surgical floor where children age newborn to eighteen months of age are cared for. On the day of data collection, nursing documentation of pain AIR cycles was noted 66.67% of the time. The unit’s Area Action Council (AAC), a shared governance group of nursing leaders and staff nurses for the unit, evaluated nursing knowledge, pain AIR cycle documentation education, systems and processes that supported this nursing practice. Staff nurses identified a knowledge deficit regarding pain assessment tools used for newborns versus older infants. The staff nurses also noted that the rapid rate of change made it difficult to assimilate information and they requested ongoing education reminders to keep practice changes in the forefront. The staff nurses also noted that their patient flowsheet required pain to be documented in numerous places. This duplication of pain documentation caused much confusion and inconsistency in practice among nurses. The unit’s nurses were motivated to improve their practice as all other units in the hospital had significantly better compliance with pain AIR cycle documentation.
Actions to improve practice were multifold. The unit’s AAC verified that the newly implemented patient flowsheet facilitated consistent documentation of pain AIR cycles and eliminated duplication. Ongoing staff nurse education was a priority action. Methods included providing education at change of shift report, a weekly E-mail newsletter with clarifications on how to use infant pain assessment tools and documentation; and short focused education highlights on pain in the staff restrooms called “Learning in the Loo.” The most significant improvement occurred when the supervisory charge nurses audited completed medical records for all discharged patients using the NDNQI pain assessment tool. The audit information was used as an opportunity to mentor individual nurses on how to improve their pain AIR cycle documentation and clarify misconceptions. The results of these efforts were very positive. A sustained improvement has been with pain AIR cycle documentation at 100% compliance. This improvement has been maintained over three quarters through the second quarter 2006.
While repeated education and clarification of practice is important, the most significant impact was seen when the individual nurse’s performance was highlighted. Prior to this mentoring, the staff nurses stated that they felt their performance had no impact on the audit results as they didn’t make mistakes. When the supervisory charge nurse met with individual nurses on their poor documentation, the nurses became vested in improvement. Focused attention on complete pain cycle documentation has helped nurses to understand the key aspects of pain management and the effectiveness of their interventions.
- The learner will understand the importance of nursing knowledge; pain assessment, intervention, response (AIR) documentation education; and related systems to support sustained quality improvement.
- The learner will recognize the value of highlighting an individual nurse’s performance to invest the nurse in improving pain AIR cycle documentation.
Analysis of second quarter 2005 NDNQI pain AIR cycle documentation showed an opportunity for improvement on a medical-surgical floor where children age newborn to eighteen months of age are cared for. On the day of data collection, nursing documentation of pain AIR cycles was noted 66.67% of the time. The unit’s Area Action Council (AAC), a shared governance group of nursing leaders and staff nurses for the unit, evaluated nursing knowledge, pain AIR cycle documentation education, systems and processes that supported this nursing practice. Staff nurses identified a knowledge deficit regarding pain assessment tools used for newborns versus older infants. The staff nurses also noted that the rapid rate of change made it difficult to assimilate information and they requested ongoing education reminders to keep practice changes in the forefront. The staff nurses also noted that their patient flowsheet required pain to be documented in numerous places. This duplication of pain documentation caused much confusion and inconsistency in practice among nurses. The unit’s nurses were motivated to improve their practice as all other units in the hospital had significantly better compliance with pain AIR cycle documentation.
Actions to improve practice were multifold. The unit’s AAC verified that the newly implemented patient flowsheet facilitated consistent documentation of pain AIR cycles and eliminated duplication. Ongoing staff nurse education was a priority action. Methods included providing education at change of shift report, a weekly E-mail newsletter with clarifications on how to use infant pain assessment tools and documentation; and short focused education highlights on pain in the staff restrooms called “Learning in the Loo.” The most significant improvement occurred when the supervisory charge nurses audited completed medical records for all discharged patients using the NDNQI pain assessment tool. The audit information was used as an opportunity to mentor individual nurses on how to improve their pain AIR cycle documentation and clarify misconceptions. The results of these efforts were very positive. A sustained improvement has been with pain AIR cycle documentation at 100% compliance. This improvement has been maintained over three quarters through the second quarter 2006.
While repeated education and clarification of practice is important, the most significant impact was seen when the individual nurse’s performance was highlighted. Prior to this mentoring, the staff nurses stated that they felt their performance had no impact on the audit results as they didn’t make mistakes. When the supervisory charge nurse met with individual nurses on their poor documentation, the nurses became vested in improvement. Focused attention on complete pain cycle documentation has helped nurses to understand the key aspects of pain management and the effectiveness of their interventions.
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