Strategic Utilization of Technology for Pain Management Process Improvement in a Pediatric Acute Care Facility

Purpose:
Pain reassessment rates were consistently low at this pediatric facility. Interventions to standardize auditing ease through the EMR allowed for increased audit frequency and real time follow-up with staff. This increased AIR cycle compliance, patient pain management and satisfaction.

Significance:
Pain often accompanies patients with various illnesses. If not assessed and treated, pain can greatly impact the patient's care. Undertreated pain can: decrease function & delay rehabilitation; cause sleep deprivation which decreases ability to cope & delays wound healing; and increases anxiety.

Strategy and Implementation:
A multidisciplinary team assembled to develop interventions to increase pain reassessment compliance. First, pain auditing practices were standardized with the use of AIR (Assessment, Intervention, Reassessment) cycles, allowing for internal and external benchmarking. Next, a customized EMR pain report was developed for real-time acquisition of pain documentation in the EMR by patient, unit, and/or date. These improvements enabled an increase in pain AIR auditing to weekly by quality department and monthly by Pain Resource Nurses. Units posted audit results, educated staff on AIR cycles and pain management, and followed-up with noncompliant nurses identified in the audits. Some units utilized charge or resource RNs to pull the EMR pain report and conduct real-time audits. However, this was only done consistently at every shift in the NICU. Data was collected weekly for 15 weeks by unit for trending and comparison amongst units.

Evaluation:
Pain reassessment rose from 56% in Fall 08, to 89% in June 09. Overall Pain AIR cycles have remained above 88% since April 09. The EMR pain report allows for easy, real-time standardized auditing & immediate staff education, dramatically improving pain reassessment compliance & patient care.

Implications for Practice:
Customizing the EMR optimized the technology to gain benefits of the automated system. This, along with standardization of practice, can be applied to other clinical goals to increase the frequency and ease of data collection, benchmarking, and improve quality practices throughout the hospital.