Quality in Pain Management: Asking the Patient

Purpose:
Improve pain satisfaction by implementing the use of scripting by RN changes behavior & culture and is more effective than education alone. Press Ganey lacks sensitivity to measure QI strategies. The APS-POQ-R is used to measure pain satisfaction QI activities & measures 6 other aspects of quality.

Significance:
Poor pain management leads to impaired health, decrease pt. satisfaction, & increase healthcare costs. If education is paired with tools that change RN behavior & culture, practice changes are more likely to occur. Scripting is a tool to help RN talk with patients about pain and changes RN behavior.

Strategy and Implementation:
The American Pain Society Revised Patient Outcome Questionnaire (APS-POQ-R) was administered to a random sample of inpatients upon discharge on two similar medical adult acute care units. Both units care for similar patients & MDs admit medical patients based only on bed availability. Only staff and management differ. Press Ganey scores on both units were consistently lower than the hospital's goal. 2 graduate nursing students verbally solicited APS-POQ-R prior to, & after providing education about pain assessment to all RN staff. All RNs on both units were provided standard education on pain assessment. On Unit "A" only education was provided. On Unit “B” RNs were asked to consistently use pain scripting during pain assessments. Samples of written scripts were placed strategically on the EMR stations as reminders and RNs used a check list if a script was used. During that period the APS-POQ-R was administered to a random sample of patients just prior to discharge on both units.

Evaluation:
Comparing 2 units, A as control & using scripting on B, showed overall improvement in patient pain satisfaction on unit B. Providing scripts, with reminders significantly improved RN & patient communication. Also patients were more likely to use nonpharmacologic interventions when scripting used.

Implications for Practice:
Providing staff RNs with useful strategies or tools along with educational material may lead to behavioral & cultural changes that improve patient pain satisfaction outcomes. Asking about pain opens communication. The APS-POQ-R survey showed additional opportunities to improve pain management.