Pain management—Continuum of care for surgical patients - Home Study Program

AORN Journal,  Sept, 2003  by Sharon W. Chavis,  Linda H. Duncan

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The article "Pain management-Continuum of care for surgical patients" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Sept 30, 2006.

Complete the examination answer sheet and learner evaluation found on pages 403-404 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on pain management-continuum of care for surgical patients, nurses will be able to

1. explain the rationale that justified the need for a pain management process improvement (PI) project;

2. discuss how the FOCUS-PDSA (ie, find, organize, clarify, understand, stabilize-plan, do, study, act) strategy was used to detect major issues that PI team members felt needed to be resolved;

3. describe the PI action plan established to resolve identified pain management problems in both facilities;and

4. discuss whether established goals were accomplished by the PI project.

Pain management is a hot topic in health care today, in part because of the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO's) standards for pain management.

   "The patient's right to pain management
   is respected and supported. The
   health care organization plans, supports,
   and coordinates activities and
   resources to assure the pain of all
   patients is recognized and addressed
   appropriately." (1 (p RI14-14a))

With this goal in mind, Centra Health surgical services division became proactive in improving pain management for surgical patients. Lynchburg General Hospital (LGH), Lynchburg, Va, and Virginia Baptist Hospital (VBH), Lynchburg, Va, comprise the acute care settings for outpatient and inpatient surgical services of Centra Health, a nonprofit health care system in central Virginia. Bedside clinical nurses were the driving force behold the pain management initiative. A core group of nurses recognized the need for a more consistent way to address pain management for surgical patients.

Preexisting processes reflected that patient care delivery on each hospital campus and in each area of surgical services operated independently instead of collaboratively in efforts to manage patients' comfort and function levels. For example, the pain scales used varied from area to area (eg, zero to five, zero to 10, faces, behavioral). In addition, patient needs were being met with respect and consideration only to a specified end point of service. A fragmented approach in the delivery of patient care and pain management was evident.

A group of perioperative nurses at Centra Health who are dedicated to improving pain management recognized the need to develop a comprehensive and collaborative approach to pain management. The group submitted a request to administrators to form a service-wide performance improvement (PI) team with an ultimate goal of improving pain management. Upon receiving full approval, a team consisting of dedicated nursing staff members, surgeons, anesthesia care providers, pharmacists, and other key hospital personnel was formed. Team members were hand selected for the group and soon became the surgical services PI team for pain management.

RATIONALE AND BACKGROUND

The PI team members included representatives from both campuses and all involved departments, including

* preoperative education and testing centers,

* surgery centers (eg, preoperative phase and phase II recovery),

* ORs,

* postanesthesia care units (PACUs),

* surgical informatics, and

* endoscopy units.

Team members also included consultants from the pharmacy department and the Centra Health pain council. Additionally, it was determined that input from the department of anesthesia would be vital in ensuring the implementation and success of any improvements in pain management for surgical patients; therefore, individuals (ie, key champions) from the anesthesia department at each campus who were known to have vested interest in pain management were approached. They willingly agreed to serve as a critical resource for team members.

IDENTIFICATION OF MAJOR ISSUES

The PI team developed and launched a course of action using the FOCUS-PDSA process improvement strategy. This process entails

* F--finding a process that needs improvement,

* O--organizing a project team,

* C--clarifying the process,

* U--understanding the process, and