Utilizing NDNQIŽ for Multi-Site Pain Care Quality Project: Successes and Lessons Learned

Purpose:
The overarching goal of this project was to implement and evaluate an innovative translational research program to measure and improve pain care processes and outcomes in a sample of United States hospitals.

Background/Significance:
Unrelieved pain contributes to increased recovery time, poor immune function and unwillingness to cooperate with treatment. Nurses are the front-line caregivers in pain management, whose responsibilities include assessment, initiation of pain relief strategies, evaluation of pain treatment effectiveness and collaboration with an interdisciplinary team. Currently, there is not a national consensus measure of nurse-sensitive pain quality indicator.

Methods:
Current NDNQIŽ members were recruited to participate in this research study. Each facility (n=326) designated a coordinator to receive study materials. On a designated day, trained RNs collected patients' opinions of pain management on seven types of non-critical care units (n=1611). Data were entered into customized spreadsheets and submitted via email or secure file upload website. Participants received a report containing unit level data for their facility and national comparison data. Units with the most room for improvement were randomly assigned into one of three intervention groups. Data collection on all units was repeated six months later to evaluate pain care quality processes.

Results:
Two types of challenges encountered were: maintaining the project schedule and communicating updates to study coordinators. One of the biggest challenges was getting IRB approval from 326 hospitals. Hospital IRBs need at least two months to review research studies. The project timeline and highlighting dates for receiving and submitting materials and data should be distributed to coordinators at the beginning of the project. Although convenient and cost-effective, email did not prevent some misunderstanding of the protocol. Regularly scheduled teleconferences and a project-specific website would have provided the redundancy needed for full understanding and confirmed receipt of materials.

Conclusions and Implications for Practice:
The coordination of a nation-wide research project amongst hospitals requires a high level of organization, a detailed timeline and redundant communication protocols. Partnership with an established nation-wide database and having a well thought out plan prior to data collection are key.