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Pilot of a Toolkit for the Implementation of the PAINLESS Pathway: Improving Pain Control for the Short Stay Resident Funded in 2011 AMDA/Pfizer QI Award. Project Team. Paul S. Sanders, MD – Medical Director for the Benedictine Health System Phyllis M. Gaspar, Ph.D., RN
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Pilot of a Toolkit for the Implementation of the PAINLESS Pathway: Improving Pain Control for the Short Stay Resident Funded in 2011 AMDA/Pfizer QI Award
Project Team • Paul S. Sanders, MD – Medical Director for the Benedictine Health System • Phyllis M. Gaspar, Ph.D., RN • Murthy Gokula, MD, CMD • Deb Jeranek, RN, MS Recognition of research assistants on site and in data analysis
Factors Contributing to Inadequate Pain Management for SSU Residents
Purpose Evaluate the implementation of the PAINLESS pathway (Pain Assessment & Intervention: Necessary Ladder for Effective Short Stays) Designed to improve the quality of care of SSU residents through the management of acute and persistent pain.
Implementation of PAINLESS • Evidence based pathway developed • Engaging strategies: Prescribers • Input from prescribers • On-site meeting • Feedback on draft pathways • Engaging strategies: Nursing staff • Establishing nurse champions • Certification in pain management • Formal and information education • Feedback on monthly basis
Setting • Two short stay units in a Midwest Metropolitan area
Data collection Process was repeated for 3 months following implementation of the protocol Survey conducted to evaluate implementation
Data Analysis • Congruence of documented management with the pathway established for each pain occurrence by MD (Agreement between 3 MDs ) • Excel database was created and transposed to an SPSS database for statistical analysis. • Descriptive analysis • log transformation (wide variance in # of occurrences of pain management between subjects) • Content analysis of the evaluation survey responses
Table 4. Frequency and percentage of pain management pathways
Pain Medication Administration • # of pain medication occurrences (N=85) • ranged from 1 to 99 per subject • mean of 21.64 times • % of congruence with the pain management protocol • close to 100% • indicating that prescribers were following the protocol overall.
Discussion • Congruence of the use of a pain management pathway approached 100%. • Low use of numerical ratings concern • Cognitive ability of residents • Environmental confounders • Low census at site B • Medical director change at site B • Staff turnover
Knowing is not enough; • We must apply. • Willing is not enough; • We must do. • Goethe