The Common Sense Guide to Improving Palliative Care > Preventing, Assessing, and Treating Pain > 4.7 Identifying and Testing Changes

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 and Testing Changes

Team Faith

To reach its aim, Team Faith eventually chose five changes.

  1. Make pain the "Fifth Vital Sign," which is recorded on admission and on every contact with patient or family.
  2. Change the current pain protocol so that nurses routinely follow up with patients every two hours until the pain goal is met.
  3. Involve physicians and pharmacists in developing preprinted order sets to get escalations of doses to patients promptly.
  4. Have kits of backup medications in the home to cover the most likely escalation of the dose.
  5. For severe pain, be able to have a nurse at the home within three hours.

Team Faith made each change on a small scale by having one nurse try out the new processes on her patients. By testing one change at a time, the team could see which changes led to improvements. When they were satisfied that the change was working smoothly and improved performance, they included more nurses and patients. In the first few weeks, the team was disappointed to find that patient pain measurements were not improving. Team members spent time observing how the changes were being implemented, and they helped the frontline nurses change the workflow so that they had the scale at hand to help patients and families report on pain.

Other successful pain improvement teams have tried changes such as the following.

Figure 4.2. Wong-Baker FACES Pain Scale. From Hockenberry, J. J., Wilson, D., & Winkelstein, M. L. (2005). <i>Wong's Essentials of Pediatric Nursing</i> (7th ed., p. 1259). St. Louis: Elsevier.  Used with permission.

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Figure 4.2. Wong-Baker FACES Pain Scale. From Hockenberry, J. J., Wilson, D., & Winkelstein, M. L. (2005). Wong's Essentials of Pediatric Nursing (7th ed., p. 1259). St. Louis: Elsevier. Used with permission.

What Are Some Changes to Try in Managing Pain and Other Symptoms?

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