D156 Improving Inpatient Pain Management Protocols and Training

D156 Improving Inpatient Pain Management Protocols and Training

Student Name

Western Governors University

D156 Business Case Analysis for Healthcare Improvement

Prof. Name:

Date

D156 Improving Inpatient Pain Management Protocols and Training

Healthcare Improvement Project: Introduction and Project Initiation

Organizational Problem

The selected Healthcare Improvement Project focuses on revising and updating policies and educational practices regarding the administration of pain medication in the inpatient unit. This issue arose after a recent Joint Commission survey revealed inconsistencies in documentation where patients received pain medications that did not match their reported pain levels. For instance, a patient who reported a pain level of 9 was administered Tramadol, which was designated only for pain levels of 4 to 6. This mismatch pointed to the absence of a policy ensuring patients have pain medication prescribed for every possible pain intensity. Upon investigation, although a pain medication algorithm was available specifying which medications could be prescribed for various pain levels, no protocol mandated that prescriptions cover all pain levels. The inpatient unit is relatively small, with a census ranging between 2 and 14 patients and 2-3 nurses per shift. The hospitalist group manages daily patient visits, with a nurse practitioner (NP) attending five days weekly and a physician twice a week. The NP predominantly prescribes medications. This streamlined care structure should facilitate coordination among providers and pharmacists to ensure comprehensive pain medication orders for all pain levels.

Stakeholders

Key stakeholders involved in this improvement initiative include the Med/Surg unit director, the pharmacist, the prescribing provider, and the charge nurse on the floor. The Med/Surg director is responsible for drafting and implementing updated policies as well as educating staff. The pharmacist reviews and approves medication orders, collaborating with the provider to verify appropriateness. The provider holds the authority to prescribe medications, while the charge nurse plays a pivotal role in applying new policies and educating nursing staff. These stakeholders have vested interests in the project’s success, as any lapses in pain medication management could lead to reduced CMS reimbursements, diminished patient satisfaction, and compromised patient care. Their influence enables them to develop policies and educational programs aimed at minimizing adverse outcomes. The productive working relationship between the provider and pharmacist is instrumental in ensuring proper pain medication management, while nursing leadership ensures staff compliance through education and policy enforcement.

Project Team

The project manager plays a critical role by assembling the team, securing necessary resources, and ensuring alignment toward a shared goal. Responsibilities include selecting knowledgeable team members, coordinating educational materials, and maintaining communication with both the team and the patient population affected by the project. Quality management and outcome monitoring also fall under the project manager’s purview (VanDenBerg, 2023). Two key skills contributing to project success are effective interpersonal communication and multitasking. For example, the Med/Surg unit director collaborates closely with the project manager to implement new policies and oversee auditing to ensure accurate pain assessment and medication administration.

Needs Assessment

The root cause of the problem was identified using the “Five Whys” technique. By repeatedly asking why patients received inappropriate pain medication, the team concluded that lack of education and awareness among providers and nursing staff was the primary issue. Providers were unaware of the need to prescribe pain medication covering all levels of pain, and nursing staff lacked sufficient knowledge on pain assessment and matching medication to reported pain levels. The assessment highlighted a knowledge gap rather than procedural inadequacy.

SWOT Analysis

Mitigation Strategies:

• Encourage open communication and weekly meetings among providers and pharmacists to maintain transparency and collaboration.

• Educate nursing staff thoroughly to improve pain assessment skills and medication administration.

• Engage patients with clear explanations about pain medication rationale to mitigate dissatisfaction.

• Conduct regular audits to ensure adherence to policies and proper pain management.

Impact Analysis

The project’s benefit score was 11, and risk score was 8, resulting in an impact ratio of 1.4, indicating that the benefits surpass the risks. Organizational benefits include appropriate patient medication management, enhanced patient satisfaction, and improved care quality. Patients benefit through better pain control, facilitating faster recovery and reducing risks from improper medication dosing. Risks include potential resistance from providers regarding prescribing practices and possible patient dissatisfaction due to perceived limitations on pain medication. Overall, the positive impact on patient outcomes and satisfaction supports project implementation.

Justification and Project Purpose

This initiative aims to optimize patient pain control by ensuring pain medication orders correspond precisely with patients’ reported pain levels. Providers and pharmacists will collaborate weekly to address prescribing barriers, while nurses will be educated to verify orders and administer medications accordingly. The project addresses identified knowledge gaps and enhances interdisciplinary collaboration to improve pain management. Strengths such as interdepartmental cooperation and administrative backing, along with targeted education and policy development, provide a robust foundation for success. While challenges exist, including potential resistance, these are manageable with education and continuous monitoring.

Review of Relevant Scholarly Sources

Several studies support the need for education and systematic pain management protocols:

• Malones et al. (2021) emphasize that improper pain assessment by nurses compromises treatment quality, underscoring an educational gap.

• Rababa and Hayajneh (2021) highlight barriers such as inconsistent pain assessment tool use and lack of standardized provider prescribing practices, recommending enhanced training and collaboration.

• Stearns et al. (2021) advocate for providers to prescribe PRN (as-needed) pain medications covering all pain levels to allow flexible and safe dosing adjustments.

• Germossa et al. (2019) demonstrate improved patient pain control following a nurse-led pain management initiative focused on education and increased patient rounding.

• Kankkunen et al. (2023) found that education improves nurses’ documentation and patient-reported pain relief, supporting ongoing training as a best practice.

The two best practices emerging from these studies are staff education on pain assessment and management, and provider prescribing of comprehensive PRN pain medication orders (Malones et al., 2021; Stearns et al., 2021).

Project Environment

The CDC’s 2022 clinical practice guideline for opioid prescribing underscores the importance of balancing benefits and risks in pain management, improving communication between clinicians and patients, and minimizing opioid-related harms (Dowell et al., 2022). This project aligns with these recommendations by fostering safe, patient-centered pain management practices.

SMART Goal

The stakeholders and project team agreed on a goal to enhance patient pain control and improve patient experiences by educating bedside nurses on proper pain assessment and medication administration. The project timeline spans from June 13, 2024, to September 30, 2024, targeting improved pain management through policy updates and education.

Project Management Lifecycle

The project follows the four traditional phases: initiation, planning, implementation, and evaluation. Initially, the problem was identified, and the project team assembled with clear goals. Planning involved developing policies and educational materials. Implementation rolled out these interventions and monitored adherence. Evaluation will assess outcomes through patient rounding and chart audits, measuring improvements in pain control and satisfaction.

SMART Goal Worksheet

SMART Project Goal:
Patients will experience a 30% increase in pain control through administration of appropriate pain medications based on their reported pain levels. This will be measured by auditing 100% of patient charts for proper assessment and medication practices before and after project implementation. Supported by collaboration among administration, providers, pharmacists, and nurses, this goal aims to enhance nursing knowledge and patient outcomes by September 30, 2024.

Process Key Performance Indicators (KPIs):

References

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports, 71(No. RR3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1

Germossa, G. N., Hellesø, R., & Sjetne, I. S. (2019). Hospitalized patients’ pain experience before and after the introduction of a nurse-based pain management program: A separate sample pre and post study. BMC Nursing, 18, 40. https://doi.org/10.1186/s12912-019-0362-y

Kankkunen, P. K., Voutilainen, A. V., Vaajoki, A. V., & Grommi, S. G. (2023). Effect of Pain Education Interventions on Registered Nurses’ Pain Management: A Systematic Review and Meta-Analysis. Pain Management Nursing. https://www.painmanagementnursing.org/article/S1524-9042(23)00061-9/fulltext

Malones, B. D., Kallmyr, S. S., Hage, V., & Eines, T. F. (2021). How hospitalized patients evaluate and report their pain together with nurses: A scoping review. Nordic Journal of Nursing Research, 41(4), 197–206. https://doi.org/10.1177/20571585211013480

Rababa, M., Al-Sabbah, S., & Hayajneh, A. A. (2021). Nurses’ Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical Care Patients: A Systematic Review. Journal of Pain Research, 14, 3475–3491. https://doi.org/10.2147/JPR.S332423

Stearns, J., Cortese, C., Remington, J., & Patil, N. (2021). Evaluation of Prescribing and Administering As-Needed Pain Medications Based on Pain Severity Scores. Innovations in Pharmacy, 12(3). https://doi.org/10.24926/iip.v12i3.4228

VanDenBerg, W. (2023). Project Manager Job Description. Project Management Certification Online at Purdue University. https://www.purdue.edu/projectmanagementcertification/news/project-manager-jobdescription-career-outlook/