Sourcebook : 3.1 Practices - Current, Better, Best : 3.1.1 Case Study - St. Mary's Health Center

Nurses, a physician, a pharmacist, a case manager, and a chaplain were on the team for St. Mary's Health Center in St. Louis, Missouri, which aimed "to improve patient satisfaction by improving the assessment and treatment of pain on in-patient medical/surgical units." The team chose this aim after finding that St. Mary's had no standard process to assess or manage pain. The team planned to create a standard that would improve assessment and reduce the response time.

Once the group had its plan, it set goals:

Assess the intensity of pain for all patients within 30 minutes of arrival in the unit.
Reduce response time to less than 30 minutes between assessment and orders to administration of pain medications for 80 percent of patients with pain greater than 3 (on a 0 to 10 scale).
Have 80 percent of patients report satisfaction with how the hospital staff managed their pain.

The team decided to try several changes:

Add a pain assessment tool that included location, intensity, and a target level to all admission forms.
Standardize the time frame for completing pain assessment.
Adapt and distribute an equianalgesic chart.
Put a pain ruler and face scale at each bedside.

Pre and post trial pain relief, St. Mary's Health Center, St. Louis, MO. Within a year, the St. Mary's team had data that reflected its success. The accompanying chart compares baseline measures to six months after the intervention began.

Other organizations might want to try some of St. Mary's starting points - for instance, to reduce the time from orders to medication administration - as a place to begin their own pain improvement projects. Groups might consider helping patients and providers define and recognize pain and to define patient and provider rights and responsibilities in terms of pain management.

Admitting Pain Assessment

Patient Name:_________________

Room #:_____

Home Phone:__________

Medical Record:__________

Date of Admission:__________

Diagnosis:_________________________

Admitting MD:_________________________

Type of Admission:_________________________

Date:

Reviewer:

Have your pain needs been met to your satisfaction during this hospitalization?

Yes_____ No_____

Comments

During this hospitalization have your experienced any unpleasant side effects from your pain medicine?

Yes_____ No_____

Comments

If Pain Noted with Score > Patient's Target

Time Interval (in minutes)	Time Interval (in minutes)	One Hour Post
Admin.
Assessment to Orders	Orders to Admin. of R_x	Numeric Pain Level (0-10)

Admission Pain Assessed (5^th VS) completed within 30 min. of Arrival (Y/N)

Presence and/or Absence Pain Noted (Y/N)

Location of Pain Noted (Location/N)

If Pain Noted, Pain Scale Utilized?(Y/N)

Numeric Pain Level (0-10)

Patient's Target Level

Date:

Reviewer:

Reprinted with permission of St. Mary's Health Center, St. Louis, MO.

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