The Common Sense Guide to Improving Palliative Care > Preventing, Assessing, and Treating Pain > 4.3 Identifying the Problem and Setting an Aim

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Identifying the Problem and Setting an Aim

Like Team Faith, you may know that patients are in pain but not know which ones are most likely to suffer and why. If your care setting is like others nationwide, chances are that your patients with advanced cancer are in pain. According to one report, almost 75% of advanced cancer patients admitted to the hospital report being in pain upon admission. Even for those known to be very near the end of life, those in pain number more than half of the admissions. What is it about current pain management protocols that is not working, and can you fix it? Nationally, women, older adults, and minorities are most likely to be undertreated for pain; what is your situation? You will need to characterize areas in which you are falling short in order to see how you might improve.

Start by forming a team of concerned and involved staff. Together, characterize why patients are in pain despite your current efforts. ­Discuss some examples (review four or five charts) and figure out the patterns.

Once you have settled on an aim, decide how to measure a trend toward success. Does the patient's pain rating decrease with each shift? Do other quality-of-life indicators improve? Is the patient better able to function? Is the pain level always below the patient's goal?

Team Faith

Rather than acting on vague ideas about a few cases, Team Faith met to discuss what each member observed, what existing data showed, and what to do. They talked about possible changes and how to test them. After a few meetings, the team chose the following aim, one around which the whole team could rally.

Aim: By August, 95% of cancer patients admitted to our hospice program will never again have pain that is worse than their pain goal and which lasts for more than eight hours.

What will improve: Pain will always be below each patient's personal pain goal within eight hours.

By when: August.

By how much: For 95% of all enrolled patients.

For whom: Cancer patients admitted to hospice with pain as a problem.

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