Improving Documentation of Pain Management at MedStar Washington Cancer Institute

Appropriate cancer pain documentation is one of the quality measures in the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI). MedStar Washington Cancer Institute has participated in QOPI since 2008, and documenting a plan of care for moderate to severe pain (which was defined as a pain score of ≥ 4 on a scale of 0 to 10, with 10 being the worst) was identified as an area for improvement.

We undertook a structured approach to improve documentation of the plan of care for moderate/severe pain with support from ASCO's Quality Training Program. Our team used standard plan-do-study-act (PDSA) methodology to achieve our goal of 90% documentation. We used a statistical process control chart (p chart) to determine whether our process was under control and to monitor the improvement in the documentation of pain management.

The baseline rate of a documented plan of care for pain was 70%. In January 2014, we implemented action plans including an electronic health record trigger for a pain score of ≥ 4, education for fellows and midlevel providers, and establishment of a faculty consensus on documenting management of pain unrelated to cancer. After these interventions, the pain documentation rate improved to 90%.

After one cycle of PDSA, we achieved our goal of a 90% pain documentation rate. To sustain our project, we continued to monitor the pain documentation rate quarterly in 2014 and continue the process of education and orientation to new staff, rotating residents, and fellows.