For instance, staff at Unique Hospice and Palliative Care Unit might think they out-perform the national average on pain management. After all, they reason, families and loved ones never complain. Even so, the group's Grade A Improvement team decides to examine the unit's performance, with the aim of showing that all patients on one unit are assessed for pain, and that pain intensity levels will be at or below a three (on a scale of 0 to 10).
How will the group know that its change — reviewing charts for pain assessment and follow-up — is an improvement? Because the team has set a goal known to be part of good practice, for instance, that patient pain intensity levels will be below a four. After reviewing five patients each week for one month on pain assessment, the team discovers that only four patients have documented assessment and follow-up procedures, and that more than half report pain intensity scores greater than five. These data are very revealing to this team who felt, like others, that no improvement was needed in their pain management program.
What changes can the team now do that will lead to improvement? The team begins a second improvement cycle and decides to make "Pain a Fifth Vital Sign." Ongoing data collection will help them determine whether the team has reached its goal of 100% of patients being routinely assessed for pain and the appropriate intervention for pain relief undertaken.
This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.