Inpatient Pain Medication Administration: Understanding the Process and Its Delays

Background: A patient's impression of quality of care is strongly influenced by pain management. Materials and methods: We sought to understand the process of pro re nata (PRN) pain medication administration through direct observation and use of timestamped data fromthe electronic medical record (EMR). The total time fromnurse notification to administration was compared between PRN narcotics, non-narcotic pain, and nonpain medications. Results: We noted two pathways: patient-initiated requests and nurses preemptively asking about pain. We observed 44 instances of PRN medication administration (33 narcotics, 5 nonnarcotics, 6 nonpain). Patients waited a median of 14.5 min for all PRN medications, interquartile range 6.5, 36. There was no significant difference in times for the patient-initiated pathway (n = 39, median 15 min, [7, 40]) compared to preemptive rounding (n = 5, 10 min [5, 30]), P = 0.88. Narcotics(median14 min,[5,30]) didnot take longerthan non-narcotic(11, [10,88]) or non pain medications(19.5,[11,40]), P = 0.75. Electronic medical record data included only the time from medication retrieval toadministration, which took approximately 5 min for all medications. Conclusions: Medication administration is complex, comprising multiple vital steps. The findings of this study suggest opportunities for process improvement that may enhance the experience and overall satisfaction of the surgical patient. Published by Elsevier Inc.