TY - JOUR
T1 - Improving the management of pain in hospitalized adults
AU - Morrison, R. Sean
AU - Meier, Diane E.
AU - Fischberg, Daniel
AU - Moore, Carlton
AU - Degenholtz, Howard
AU - Litke, Ann
AU - Maroney-Galin, Catherine
AU - Siu, Albert L.
PY - 2006/5/8
Y1 - 2006/5/8
N2 - Background: Pain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management. Methods: This controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing. Results: Units using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores. Conclusions: A clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics.
AB - Background: Pain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management. Methods: This controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing. Results: Units using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores. Conclusions: A clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics.
UR - http://www.scopus.com/inward/record.url?scp=33646432486&partnerID=8YFLogxK
U2 - 10.1001/archinte.166.9.1033
DO - 10.1001/archinte.166.9.1033
M3 - Article
C2 - 16682579
AN - SCOPUS:33646432486
SN - 0003-9926
VL - 166
SP - 1033
EP - 1039
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 9
ER -