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Pain management program 2004 - 2006

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About the pain management improvement program

Patient handed glass of waterUnrelieved or undertreated pain is recognised across the spectrum of health care in Australia, from chronic pain in the community at large to residential aged care, medical and surgical inpatients in acute hospitals and in oncology inpatients and outpatients.

In 2004, NICS' unique program brought together eight high volume cancer hospitals to take part in the first pain management improvement program in Australia. The pilot program involved multi-disciplinary teams working together to improve the day-to-day assessment and management of pain, beginning with a focus on cancer services.

The program had three main objectives:

  • To improve the day-to-day identification and management of pain in hospitals
  • To integrate effective routine pain management into the core business of hospitals
  • To capture and disseminate the lessons learned about improving routine pain management from the eight hospital pilot project

Activities

Each hospital formed pain management improvement teams in various combinations of medical and nursing staff from pain, palliative care and oncology departments, along with pharmacists, quality unit staff and overarching executive support.

Three, two-day workshops for the teams during 2004 focussed on existing evidence for improving routine pain management practices, generic improvement methods and sharing of experiences among the hospitals. All sites began on a small scale by testing changes in one to four wards initially and collected one or more agreed process indicators.

What was achieved?

Using a variety of interventions adapted to local circumstances, the percentage of patients with documented pain scores on admission to the pilot ward/s improved from generally less than 20% at baseline, to 60-100% during the active phase of the project. There were also improvements in documented daily pain scores at most sites.

Outcomes of reductions in pain severity have proven elusive, as anticipated in part by previous evidence on organisation-wide improvement initiatives for routine pain management. See the NICS commissioned systematic literature review Institutional approaches to pain assessment and management for more detailed information on this topic.

Highly valued interventions included:
  • Engaging ward-based nurses to champion the project;
  • Providing feedback on progress to ward staff;
  • Making equi-analgesic cards readily available to prescribers; and,
  • Finding creative and opportunistic ways of 'advertising' the pain improvement message.
  • Clinical champions and executive support were also important factors.

Resources and useful publications

  1. The 2003 systematic review that informed the pain management program, Institutional approaches to pain assessment & management, was commissioned by NICS and prepared by the University of Adelaide. In 2005, the American Pain Society Quality of Care Task Force published an excellent review of what's known about systematically tackling under-treated pain.
  2. Gordon DB, Dahl JL, Miaskowski C et al. American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005 Jul 25;165(14):1574-80.
  3. The Wisconsin Resource Manual book provides guidance on how to address pain management on an organisation-wide basis and includes tools, templates and useful tips. It can be ordered on-line at http://trc.wisc.edu/
  4. Gordon D, Dahl JL, Stevenson KK. Building an institutional commitment to pain management (2nd edition). Madison, WI: University of Wisconsin-Madison Board of Regents, 2000.
  5. Improving the Quality of Pain Management Through Measurement and Action. JCAHO, March 2003. A comprehensive resource from the USA Joint Commission on Accreditation of Healthcare Organizations. It looks at all aspects of improving the quality of pain management and includes four case studies from very different organisations. Free to download at http://www.jointcommission.org/

 

Related topics

Respecting patient choices program

The respecting patient choices program is a program to support advance care planning. It began in 2002 as a pilot program at the Austin Hospital, Melbourne, funded through the NICS targeted grants program.
Respecting patient choices has since been extended to a number of other hospitals and communities in Victoria. It is in the process of being piloted in other Australian states and territories.

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