Effects of a quality improvement program in acute care evaluated by patients, nurses, and physicians

Hospitalized patients have a right to be assessed for pain and receive optimal pain management, but inadequate pain management is still widely prevalent. Different quality improvement (QI) approaches have been used to improve patients' experience of pain, with varied results. The aim of this study was to implement a QI program and evaluate its effects on pain management routines in acute care, experienced by patients, nurses, and physicians. A cross-sectional intervention study was conducted with patients, nurses, and physicians assigned to a control group for 2 months in 2002 and an intervention group for 2 months in 2003. Implementation of a QI program, including pain policy and an educational program for the health care professionals, was evaluated with questionnaires. Nurses' assessment of pain at rest and pain with movement with pain rating scales increased (p < .001) after the intervention. Nurses participating in the educational program increased their knowledge of pain and changed their pain management routines and search habits for pain-related websites on the Internet. The number of patients assessed with pain rating scales increased (p = .011), but no difference was seen in patients' experience of pain severity, interference with function, or use of nonpharmacologic methods. Younger and higher-educated patients seemed to prefer a more active participation role in their pain management than did older and low-educated patients. In future research it would be valuable to illuminate patients' possibilities to participate in pain management further and test different implementation methods with varied length of educational programs including follow-ups for the whole team and the patients in acute care.