Improving pain outcomes in home health patients through implementation of an evidence-based guideline bundle

Pain is often undertreated and underreported in the elderly. Many of these individuals receive home healthcare services for management of their conditions. Home healthcare agencies (HHAs) have outcome measures that are publicly reported. The purpose of this project was to implement an evidence-based (EB) guideline bundle to improve the outcome measure "Improvement in Pain Interfering With Activity." This quality improvement (QI) project used a pre-/posttest design. The setting was a hospital-based HHA in Arizona. The target sample included Medicare patients with chronic pain and pain that interfered with activity. The approach included a review of published clinical practice guidelines addressing pain management, and identification of relevant interventions for the home healthcare setting. A bundle of three interventions was created for implementation. Clinical staff was educated on use of the bundle. Chart audits were conducted on patients meeting the inclusion criteria to determine if the bundle was used, and if the patient had an improvement in pain. There was a statistically significant improvement in the outcome "pain interfering with activity" in the patients who had the bundle (78% vs. 48%) used in their care (p = 0.007). Clinical staff readily incorporated use of the bundle into their practice, showing that implementation of an EB guideline bundle is an effective way to incorporate EB practices into the home healthcare setting.