Pain Management: Are you on target?

Purpose:
After participating in the NDNQI pain care quality study our unit found that most patients rated their pain at a 7, and did not feel involved in their pain management. A team was developed to look at the study results and implement a process improvement. The pain target sign was implemented.

Significance:
Unrelieved pain can result in many complications for the hospitalized patient. Studies link unrelieved pain to decreased mobility, dvt, pe, pneumonia, and impaired wound healing. Pain is not something a nurse can measure with a device, so patient involvement is key.

Strategy and Implementation:
The pain target sign includes a large red and white target with a white space in the center to write the patient's target pain score. The sign also includes space to write the time of last pain medication and non-pharmacological treatment options. The signs are lamenated and posted in every orthopedic patient room. Prior to posting these signs staff were educated about their use. Nursing and rehab staff were provided education during staff meetings. Patients are educated about the signs upon admission to the unit. During the initial pain assessment the nurse will discuss the target pain level and write it on the sign. Rehab staff address the pain target prior to working with the patient. Having the time of last pain medication given on the sign serves as a reminder to the patient to ask for pain medication before the pain is severe.

Evaluation:
After 6 weeks of usage data was collected again for phase II of the NDNQI study. Results did not show a significant change, but patient satisfaction studies have improved. Rehab staff like having the pain medication time posted in the room because it saves them time.

Implications for Practice:
The pain target sign is beneficial to pain management. Patients feel more in control of their pain management. Including rehab staff in the implementation process was key to create a team approach to pain management. Audits are conducted to evaluate usage of the signs.