Safely Easing Pain in Home Hospice Patients With Opioid Infusions: A Quality Improvement Project

Opioid infusions are critical for managing pain in home hospice care but carry a high risk of medication errors. This quality improvement (QI) project evaluated adherence to a standardized PCA opioid infusion procedure and examined whether a nurse education intervention improved compliance.

Compliance was assessed using a ten-item checklist that captured key safety and documentation behaviors, including double-check verification, verification of nurse documentation and identification, expiration-date documentation, photo verification, documentation of pump lock and unlock, near-miss event reporting, compliance with the protocol, and identification of adverse events. Weekly average compliance scores were calculated for 47 weeks (29 pre-intervention and 18 post-intervention).

The intervention consisted of a nurse education program focused on the standardized PCA opioid infusion procedure. Education covered double-check processes, standardized documentation using smart phrases, photo verification, and adherence to required safety steps. No patient-identifying information was collected.

Weekly average compliance scores significantly improved after the intervention (Mann-Whitney U test). Chi-square tests showed that several checklist items were significantly associated with the intervention period. Linear regression demonstrated that the intervention remained a significant predictor of higher compliance after controlling for nurse role and travel distance. No adverse events occurred during the study period.

Standardizing PCA opioid infusion procedures through focused nurse education, supported by digital documentation tools, improved compliance and strengthened patient safety in home hospice care. QI teams should consider combining education with standardized workflows and mobile documentation supports to reduce variability and enhance adherence.