Sourcebook : 3.1 Preventing, assessing, and treating pain

Kaiser-Permanente-San Diego

Hospice staff from the Kaiser-Permanente -San Diego team identified several problems: At admission, more than half of the patients admitted to the hospice had significant, uncontrolled pain. There were no standard methods for pain assessment or for follow-up on pain management. To remedy this problem, the team began to hold bi-weekly meetings, creating for the first time a sustained effort between hospice, continuing care, and oncology professionals.

The group focused on three aims for end-of-life patients visiting oncologists' offices:

• Meet patient pain level goals 80 percent of the time
• Make follow-up calls within three to five days when the patient's pain is greater than the patient's pain goal in 100 percent of cases
• Record pain intensity for all visits for dying patients

The team changed what had become routine by:

• Giving patients a pain questionnaire and ruler
• Assessing depression and anxiety
• Making follow-up telephone calls

At the first follow-up phone call, most patients who had been in pain still reported problems: but nearly all could be managed over the phone by a nurse. By the end of the project:

• 92 percent of patients had pain controlled upon hospice admission
• 90 percent received appropriate follow-up
• 94 percent had pain intensity documented

The team was so successful, that the project is being expanded throughout the department and Southern California Kaiser plans.

• Pre-EOL pilot Hospice reported over 50 percent of Oncology patients in significant, uncontrolled pain (level >5) prior to Hospice admission.
• EOL pilot reports 92 percent of Oncology EOL patients with controlled pain (level <= 5) prior to Hospice admission.

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