The Breakthrough Series team at United Hospital in Minneapolis, Minnesota, aimed to have 90 percent of the group's cancer patients report a pain intensity of less than 5 on a 0-to-10 pain scale. The team studied a pilot group and found that 50 percent of oncology patients were in significant, uncontrolled pain (level greater than 5) prior to hospice admission. To do this, the team tried several tactics, including the distribution of equianalgesic cards and the development of a pain liaison nurse program. Each week, staff reviewed four randomly selected charts on the oncology unit and on the four critical care units.
Changes tested included ongoing pain management education, use of multilingual pain scales, addition of pain assessment to the Nursing Admission History Form, and development of a pain protocol (standing orders) for oncology. This protocol includes substantial adjustment of doses without further physician input - an approach that seems key to rapid responses.
The pain management liaison nurse performed several roles: distributing pain management information to nurses at the bedside, increasing resources for pain management on each unit, and encouraging interest in pain management among colleagues.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].