Impact of an Advanced Practice Nurse (APRN) Led Pain Consult Service

Monday, 7 July 2008
Kimberly Rich, MS, RNC, GNP-BC , Pain Management & Palliative Care, St. Luke's Episcopal Hospital, Houston, TX
Linda Cole, MS, MSN, RNC, CNS-CC, CCRN, CCNS , Center for Advanced Clinical Practice, St. Luke's Episcopal Hospital, Houston, TX
Lisa G. Foytik, MSN, RNC, GNP-BC , Pain Management and Palliative Care, St. Luke's Episcopal Hospital, Houston, TX

Learning Objective 1: Describe quantifiable measures of success for an APRN led pain consult service

Learning Objective 2: Differentiate at least two vulnerable populations served by a specialized pain management consult service

After reviewing evidence-based practice guidelines and The Joint Commission standards, an advanced practice nurse (APRN) led pain management consultative service was developed at St Luke's Episcopal Hospital in 2002 in response to growing numbers of patients reporting chronic pain conditions. Because the service is APRN led, referrals are accepted from any member of the health care team or the patient/family. This empowers nurses, improves patient/family satisfaction, and facilitates nurse/physician communication/ collaboration.

Special care is taken with vulnerable populations such as the elderly in which APRNs w/ geriatric training and pain management certification perform the consultation. Additionally, recommendations are made for patients with low income with consideration given to the cost of therapy and availability of resources in the community.

An automated referral service is used to make most referrals and computerized daily patient census is generated. Daily computerized tracking of referral rates, referral sources, rate of recommendation acceptance by physicians, and patient pain scores is performed. The computerized nursing documentation is analyzed for response to interventions and amounts and types of medications the patient uses daily. Monthly computerized audits are done on each patient care area to analyze nursing documentation and adherence to specified pain policies.

Data tracked over the past five years has shown steady increases in patient referrals with a 60% increase in 2007. Referral rates from nurses remains high and physician referral rates have increased dramatically to 49% of all referrals in 2007. Most importantly, patients consistently report an average 50% reduction in pain scores after APRN pain management involvement.


St. Marie, B. (2002). Core Curriculum for Pain Management Nursing.

Philadelphia: W.B. Saunders.

McCaffery, M. & Pasero, C. (1999). Pain Clinical Manual (2nd ed.).

St. Louis, MI: Mosby.

The Joint Commission. Hospital Standards/Pain assessment: