Pain Care Quality and Patient Perception of Pain Care

Background: Evidence supports that quality pain management improves the patients’ report of satisfaction even if pain is not always eliminated. The goal of this Doctor of Nursing Practice project was to implement/sustain processes to enhance the patients’ perception of pain care quality by implementing a Pain Care Quality Toolkit into the standard of care for three inpatient nursing units. The setting was a 110-bed community hospital that is a part of a large multi-facility healthcare system. An interprofessional team was formed to plan, implement, and monitor all project activities.

Methods: A Plan, Do, Study, Act methodology guided project implementation and evaluation.  In July 2014, an evidence-based Pain Care Quality Toolkit was adopted involving:  communication whiteboards, pain scales, patient education, hourly rounding, and non-pharmacologic strategies (positioning, heat/ice, guided imagery, distraction).  Project outcomes included: 1) monthly collection of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) pain scores and 2) inpatient responses to the 6-item Pain Care Quality–Nursing (PainCQ-N^©) survey using a prevalence methodology.  Weekly Pain Care Quality Toolkit adherence audits were conducted and reported monthly.  Comparisons between pre-intervention (March-June, 2014) and post-intervention (July-November, 2014) outcomes were performed using paired t-tests (HCAHPS) or Wilcoxon signed rank test (PainCQ-N^©).

Results: There was a significant improvement (t=4.3822, p <0.0001) in HCAHPS pain scores for all units when pre-intervention outcomes (n=112, M=66.25%, SD=10.5%) were compared to post-intervention outcomes (n=120, M=71%, SD=5.34%).  Adherence to pain education and adjunctive pain management strategy components of the toolkit improved compared to communication of the pain plan component of the toolkit. There were no significant differences in pre- intervention (n=23) and post-intervention (n=65) PainCQ-N^© survey ratings in any of the three subscales (p >0.05): Being Treated Right pre-intervention M=5.80, SD=0.39, post-intervention M=5.35, SD=1.10 (Z=1.51, p=0.13); Comprehensive Nursing Pain Care pre-intervention M=4.72, SD=1.64, post-intervention M=4.10, SD=1.93 (Z=1.35, p=0.18); Efficacy of Pain Management pre-intervention M=5.55, SD=0.67, post-intervention M=4.98, SD=1.53 (Z=1.09, p=0.28).

Discussion:  PainCQ-N^© ratings have not demonstrated improvement despite significant increases in HCAHPS scores post-intervention. However, there are too few data points post-intervention to support any trend in improved pain care quality. Continued monitoring of adherence with utilization of the toolkit and pain care quality measures is warranted to guide and sustain process improvement.