January 29, 2016
Patient care pain rounds recently implemented at a medical/surgical unit of a Texas community hospital led to several positive outcomes for the facility itself and for its patients. The two-month interdisciplinary program resulted in initial improvements in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) pain management patient satisfaction scores, the expansion of the facility’s clinical pharmacy program, and heightened collaboration and better rapport between the pharmacy and nursing departments.
“This project shows that a real impact in patient care can be made, even with the limited resources available in a smaller, community hospital setting,” said Dr. Stephen Sapienza, East Houston Regional Medical Center in Houston, Texas. “We have a limited clinical staff, but we were still able to increase our patients’ satisfaction with regard to their pain management.”
If an individual’s pain is not adequately controlled, he or she may experience diminished quality of life and patient satisfaction, as well as longer hospital stays and increased hospital readmissions for uncontrolled pain, the authors noted. “While being hospitalized is often inherently uncomfortable, we want our patients to be as comfortable as possible within reason,” he said. “Appropriate use of pain medications and adequate pain control is essential to achieving this goal.”
The primary motivation for the project was to help increase the facility’s HCAHPS survey scores with regard to inpatient pain management satisfaction, said Dr. Sapienza. Further, the authors wanted to aid in meeting the Joint Commission’s standards for pain management, which state that every individual “has the right to have his or her pain assessed and treated adequately,” according to the poster.
The patient care rounds were implemented at their institution from April 2015 to June 2015. Primary team members included a clinical pharmacist and a nursing department representative, such as the unit nursing director or a charge nurse.
Pharmacy to nursing interventions and pharmacy to provider interventions were recorded electronically, and HCAHPS pain management patient satisfaction scores were obtained quarterly.
Patient interviews included specific questions related to the timeliness of nursing response to pain medication requests, overall control of the patient’s pain during his or her hospital stay, and his or her current pain level, which had to be rated on a scale of 1 to 10. Further, the pharmacy department provided information to the patients about their current pain medications, and asked them about their medications’ effectiveness and adverse effects.
Reports of inadequate pain management were initially referred to the patients’ nurses. If a change in medication was required, the pharmacist would make a recommendation to the provider.
There was a total of 154 pain management interventions recorded during the eight-week period (124 pharmacy to nursing interventions and 30 pharmacy to provider interventions).
Nearly 80% of the pharmacy to nursing interventions were related to informing the nurse that a patient in pain needed his or her pain medication administered. Further, 15% of these interventions involved patients asking for the administration of medications for medication side effects, such as opioid-induced constipation.
Over 40% of pharmacy to provider interventions pertained to the need to increase the frequency of a patient’s pain medications, and nearly 30% of these interventions were related to a clarification of a pain scale.
HCAHPS patient satisfaction survey results for the third quarter indicated that 56% of patients thought that their pain was well controlled during their entire stay on the unit.
“When the project was started in April, I was the only clinical pharmacist on staff and was doing pain rounding in addition to my other clinical duties,” Dr. Sapienza noted. “At the conclusion of the pilot in June, we had not yet seen a large increase in patient satisfaction; however, the slight increase did represent a reversal of a six-month trend of static scores. At the conclusion of the pilot, the limited results were positive enough that administration realized the potential of the pain rounds project, and approved a second clinical pharmacist FTE specifically for deployment on our medical/surgical units with a major goal of focusing on the pain rounds.”
After the addition of a full-time clinical pharmacist FTE, pain management patient satisfaction scores were measured at 79% for the fourth quarter. “Having a clinical pharmacist dedicated to these units (and the daily pain rounds) made a huge impact, as evidenced by the 25% increase in satisfaction scores from 3Q15 to 4Q15,” he said.
There were other benefits observed after the implementation of this project. For example, “The response from nursing and patients to having a clinical pharmacist on the floor helping with pain rounds was extremely positive,” said Dr. Sapienza. “Having an individual on the floor improved rapport between the pharmacy and nursing departments, as well increased our patients’ awareness of the other clinical pharmacy services offered by our facility.”
He also said that a facility’s size should not prohibit one from trying to implement a patient care project. “We are a small community hospital with limited resources compared to many other hospitals,” said Dr. Sapienza. “That being said, we were still able to make a very positive impact on our patient experience, as well as justify to our administration the important role clinical pharmacy plays in patient care. If a pharmacist at a smaller facility has a great idea for a project to improve patient care, they should definitely explore it further. I think that it’s important to remember that great ideas and excellent projects can come from any size facility.”
The results were reported at a poster session titled “Implementation of Interdisciplinary Patient Care Pain Rounds at a Small Community Hospital” at the 50th ASHP Midyear Clinical Meeting and Exhibition.
-Meredith Edwards White
1. Sapienza S, Omari A, Vallier A. Implementation of interdisciplinary patient care pain rounds at a small community hospital. Presented at: 50th Midyear meeting of the American Society of Health-System Pharmacists. December 10, 2015; New Orleans, LA. Poster presentation.