Quality improvement initiative for chronic pain assessment and management in the nursing home: A pilot study

Objectives: To improve assessment and management of chronic pain in the nursing home through a method of continuous quality improvement. Design: Quality improvement. Setting: One nursing home in North Carolina as the primary site and 3 related facilities as secondary sites. Intervention: Formation of a quality improvement team that reviewed current clinical practice guidelines, updated the policies and procedures, developed tools for pain assessment, and educated the staff in pain assessment and management principles. The "Plan-Do-Study-Act" (PDSA) paradigm was employed. Measurement. The staff's pain-related knowledge was measured with multiple-choice tests before and after an educational program. The completeness of the documentation and satisfaction of patients and families with pain assessment and management were also measured before and after the intervention. Results: Before the intervention, the mean number of questions correct on the staff test was highest among the registered nurses (RN) (13.7 out of 16), intermediate among the licensed practical nurses (LPN) (12.4), and lowest among the certified nursing assistants (CNA) (9.4). After the intervention the scores were 16 for the RNs, 12.9 for the LPNs, and 12.0 for the CNAs. In addition, 8 of 9 elements of a complete pain assessment showed improvement in documentation. The level of satisfaction for both the patients and families measured by interviews also increased. Conclusion: Education and use of the PDSA paradigm improved staff knowledge and patient and family satisfaction with chronic pain assessment and management.