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Knowledge translation and process improvement interventions increased pain assessment documentation in a large
Daniel Stocki1,2, Conor McDonnell3,4, Gail Wong3
1Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Implementing a knowledge translation strategy significantly improved pediatric pain assessment documentation in the post-anaesthetic care unit, reaching 100% within six months.
Area of Science:
- Pediatric Anesthesiology
- Quality Improvement Science
- Nursing Practice
Background:
- Inadequate pain assessment documentation in pediatric post-anaesthetic care units (PACU) hindered monitoring of pain intensity.
- This limitation prevented targeting factors contributing to moderate and severe postoperative pain in children.
Purpose of the Study:
- To enhance pain assessment documentation in the PACU.
- To implement a process improvement intervention combined with a knowledge translation (KT) strategy.
Main Methods:
- Utilized the Plan-Do-Study-Act (PDSA) quality improvement model.
- Conducted pre-intervention chart review of 99 patient records and post-intervention audits at 4, 5, and 6 months.
- Implemented modified PACU flowsheets and a KT strategy including education, reminders, and feedback for nursing staff.
Main Results:
- Pre-intervention, only 69% of charts included documented pain assessment.
- Post-intervention, pain assessment documentation increased to over 90% at 4 and 5 months.
- Achieved 100% pain assessment documentation by 6 months post-intervention.
Conclusions:
- Process improvement and KT interventions effectively enhanced pain assessment documentation in the PACU.
- Further efforts are required to monitor moderate to severe pain and address its contributing factors in pediatric postoperative patients.
Background:
Due to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital. Participants included PACU and Acute Pain Service nursing staff, administrative staff and anaesthesiologists.
Methods:
The Plan-Do-Study-Act method of quality improvement was used. Benchmark data were obtained by chart review of 99 patient medical records prior to interventions. Data included pain assessment documentation (pain intensity score, use of validated pain intensity measure) during PACU stay. Repeat chart audit took place at 4, 5 and 6 months after the intervention.
Intervention:
Key informant interviews were conducted to identify barriers to pain assessment documentation. A process improvement was implemented whereby the PACU flowsheets were modified to facilitate pain assessment documentation. KT strategy was implemented to increase awareness of pain assessment documentation and to provide the knowledge, skill and judgement to support this practice. The KT strategy was directed at PACU nursing staff and comprised education outreach (educational meetings for PACU nurses, discussions at daily huddles), reminders (screensavers, bedside posters, email reminders) and feedback of audit results.
Results:
The proportion of charts that included at least one documented pain assessment was 69%. After intervention, pain assessment documentation increased to >90% at 4 and 5 months, respectively, and to 100% after 6 months.
Conclusion:
After implementing process improvement and KT interventions, pain assessment documentation improved. Additional work is needed in several key areas, specifically monitoring moderate to severe pain, in order to target factors contributing to significant postoperative pain in children.
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