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Learning Objective 1: Identify steps of implementing a pharmacy consult program, lead by a clinical nurse specialist, to affect patient satisfaction with pain management.
Learning Objective 2: Describe the role of Six Sigma Methodolgy applied to practice improvement and patient satisfaction.
Our goal as a Health System is >90th percentile in key publicly reported indicators. Patient satisfaction with pain management indicated a downward trend compared to fiscal year 2009.
Significance
Our project purpose is to increase patient satisfaction related to pain management to at or above the 90th percentile (QDM) and to 67.0 (RBC) in Q3 (April/May/June) FY 2010.
Literature supports decreased patient satisfaction related to pain management affects complaints, compliance, and safety. Financial impact is difficult to assign, the cost of poor quality could be the customer choosing a different facility, increased length of stay and/or complications.
Description
Using Six Sigma methodology and review of evidence, a multidisciplinary team formed to review current status. The intervention accepted for pilot was pharmacist bedside consultation with patients. Pharmacist education moved forward. Patients were identified during daily progression meetings. Triggers for pharmacy consults included PCA utilization > 48 hours, frequent PRN medication administration, pain uncontrolled by current regimen and RN/MD request.
Outcomes
Consults began May 14th, 2010. To date, 20 patients have received pharmacist consultation. 15 had recommendations accepted by the physician, 1 partially, 1 not accepted, 3 n/a. Mean pain score prior to consultation 4.329, after consultation was 2.84. Quality data improved in QDM and RBC categories.
Conclusions
Pain management consults appear to have a positive impact on average pain scores. Verbal feedback by patients has been positive. Limitations to this service include pharmacy hours, staffing levels, patient acuity, hospital census, patient recognition, and tasks.
Implications
Research supports that pain intensity is only one factor to be considered, other factors are: patient expectation, patient education and quality of interaction with health care providers. IRB approval is underway to survey patients/families assessing these factors.
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