Sourcebook : 3.1 Preventing, assessing, and treating pain

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 and surgical units." After finding that St. Mary's had no standard process to assess or manage pain, the team decided to create one to improve assessment and reduce the response time. The team's goals were to:

• 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 1 to 10 scale)
• Have 80 percent of patients report satisfaction with how the hospital staff managed their pain

The team tried several changes:

• Added a pain assessment tool that included location, intensity, and a target level to all admission forms
• Standardized the time frame for completing pain assessment
• Adapted and distributed an equianalgesic chart
• Put a pain ruler and face scale at each bedside.

Within a year, the St. Mary's team had data that reflect 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, such as reducing the time from orders to medication administration, as a place to begin their own pain improvement projects. Groups might consider helping patients and providers to define and recognize pain, and to define patient and provider rights and responsibilities in terms of pain management.

This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.