Managing Pain, Enhancing the Patient Experience

There is so much to learn when you become a new parent. Keeping our patients comfortable enables them to focus on their new baby and not their discomfort.”

Michelle Bomer,  manager, Women Services and Childbirth
Education and project owner

 

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The patient experience. So many factors contribute to this, including noise levels, quality of care and cleanliness of a room – just to name a few. In order to obtain a measurement on our patients’ experience, inpatients receive a survey at home from Press Ganey, a health care consulting firm. The survey asks several questions related to satisfaction. The results from Press Ganey create our HCAHPS data, allowing our performance to be measured. One of the questions on the survey asks “how often was your pain well controlled?”

For our patients who had delivered a baby or underwent gynecological surgery, the marks were in the 30th percentile. “Our scores demonstrated there was room for improvement,” says Peggy Brown, clinical quality coordinator for Women and Children’s Services. “Our goal was to improve this to the 75th percentile.”

Brown led a quality improvement project that began in April 2012, meeting with a multi-disciplinary team comprised of nurses, anesthesiologists, physicians and
pharmacists. The team analyzed the data and realized the intervention could be fairly straight forward. “We weren’t routinely giving PRN (“pro re nata,” Latin for “as needed”) pain medication as often as we could,” explains Brown. “As a result, medication was not staying steady in their blood stream.”

The team determined the intervention should involve providing PRN pain medication, such as Ibuprofen, every four, six or eight hours, depending on the physician orders.

“We no longer waited for the patient to ask for pain medication. This allowed their blood levels to stay therapeutic,” says Brown.

“It is very important to keep levels of analgesic steady to avoid the ebbs and flows of pain,” says Michelle Bomer, manager, Women Services and Childbirth Education and project owner.

“Sometimes patients wait too long and their pain is worse than it needs to be because they’ve waited.”

The pilot began May 14 and went through June 9. “Analyzing our HCAHPS scores during the pilot, it was evident by June 9 this intervention was successful,” says Brown.

Scores for Women and Children’s Services steadily increased through the second and third quarters, hitting the 100th percentile mark for much of June. Scores dropped for quarter four, causing the team to investigate and respond to possible causes.

Brown continues to do spot checks on patients’ charts to make sure pain medication is offered routinely.

The associate nurse manager also rounds with patients asking about their pain control. Scores for February are again showing improvement. Brown is looking forward to reviewing quarter one scores in April. “This was a great group to work with,” reflects Brown. “The culture of this organization is to strive to fulfill our mission. Our mission is real.”

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