Clinical Quality Indicators in Pain Management

Question: Discuss about the Clinical Quality Indicators in Pain Management. Answer: Introduction The report brings into highlight the topic of post-operative pain assessment and management. Pain is a common part of almost all surgical procedures. The pain may be acute which subsides after sometime or it may be chronic which persist for long time. If this pain is not managed accurately, it may lead to adverse physical and psychological outcome both for patient as well as family members. This report provides information about three current-evidence on the topic and gives an analysis of the situation. It will also describe the challenges that one can face in implementing research finding into research practice setting and recommend solutions to the gap found in research or practice. Evidence for current practice on post-operative pain assessment and management Magidy et al., (2015) studied about the experience of post-operative pain management among hospitalized patients in Swedish health care. The health clinic engaged patient in the process and took feedback from patients regarding the quality of pain management. It mainly compared the experience of acutely and electively admitted patients who had soft-tissue surgery. A multi-dimensional tool called Strategic and Clinical Quality Indicators in pain management (SCQIP) was used to assess patients experience and this feedback was taken before discharge from hospital. The questionnaire consisted of four aspects such as patients perspective about pre-operative knowledge of pain, level of post-operative care and treatment for post-operative pain in the hospital, patient involvement in care and equipments and facilities given for relief. Among 160 participants consisting of acutely admitted and electively admitted patients, who gave rating for quality of pain management, it was found that poor rating was given for pain management compared to electively admitted patients. There is a need to enhance post-operative care so that no patient experience poor post-operative care. Current evidence on post-operative pain management and treatment suggest that suboptimal outcome will persist as long as health clinic do not take guidance from best scientific research. Bott et al (2014) explained that incorporation of algorithm derived from best evidenced based practice may help in improving the quality of pain assessment. The study mainly focused on creating an algorithm for patients with total hip replacement surgery. In association with experienced physicians, the focus of the group was to develop an algorithm that supports pain management decisions. It was also necessary to identify barriers and enablers in implementation algorithm. The first step was to identify the issues in pain management such as practice of prescribing analgesics and creating an analgesic guideline specific to total knee replacement patients. Prevalence and intensity of pain was judged by interview with patients. A pharmacological pain treatment survey was also done to determine the types of analgesics given prior to hospitalization, intra-operatively and 24 hour prior to interview. This helped in identifying the need to change current practices and develop accurate guideline according to intensity of pain and their impact on daily living. One study provided details on nurses experience of post-operative pain assessment and how it influenced their pain management decisions. The common barrier that interferes with high quality of pain-management in nursing practice includes shortage of staff, high workloads and lack of skills in pain assessment. It was found that quality of pain assessment depends a lot on competence of nurses. However, poor outcome was mainly seen because of variation in pain assessment skills and lack of interpretation of pain in patients. It is also important to assess pain score and reassess pain after administration of medications. However, many nurses do not reassess patients leading to poor pain management. Hence, nurses ability to assess pain varied and this affected the accuracy of the process. It is necessary to enhance their skill and prevent delay in pain by keeping novice nurse under the supervision of competent nurse (Chatchumni et al., 2016). Situational analysis on practices of pain management The evidence from current literature revealed that inaccuracy in pain management and assessment continue to exist despite several tools and support available to enhance post-operative care. Common form of barrier include lack of competence skill among nurses to manage pain, absence of appropriate framework or guideline to implement pain assessment process and difference in care given to acutely and selectively admitted patients. It is critical to address the gap in implementing best-evidence based care in pain management and assessment. If overlooked, this situation may lead to hazardous health complications like delayed healing, pneumonia, persistence of chronic pain, infection, pneumonia and other health issues. Current progress on quality of pain assessment suggests it is extremely important that accurate pain management practice is implemented in hospital setting (Hudson et al., 2015). Challenges in implementing pain management practices From situational analysis on the topic, it can be said that challenges in implementing pain management practices occur mainly because of lack of competence among nurses, lack of adherence to pain management guidelines, inefficient communication skill to interpret patients pain. Apart from this type of assessment differ according to age of patients. There may be difference in the pain management of infants and adults and so gap in knowledge in this area lead to poor outcome (Kuusniemi Pyhi, 2016). Hence increased responsiveness is needed to address the gap in practice and embrace recent advances in pharmacology to enhance post-operative care. Solution to reduce research-practice gap The health care system can play a role in developing strategies to enhance post-operative pain management. They main priorities may be as follows: It is extremely important to involve patients in decisions making and educate them about pain management as many complication occurs by negligence of patients too. Secondly, it is necessary to inform patients about range of treatment and their possible outcome. Good communication of nurse or physician with patients is also important as evidence revealed that many nurse fail to interpret patients pain level which lead to poor outcome. Arrangement should be made for better professional training and increasing competence in multi-disciplinary pain management team. Optimization of treatment procedure is also essential. For example using synergistic antibiotic to target pain at different levels, adoption of patient-specific analgesia and promoting minimally invasive surgery as far as possible (Meissner et al., 2015). Restructure the organization may also help to enhance pain management by implementing best guidelines for practice, making pain services available throughout the day, imposing adherence to protocol among medical team and following recent technological advance to provide care (Joshi et al., 2014). Reference Botti, M., Kent, B., Bucknall, T., Duke, M., Johnstone, M. J., Considine, J., ... Cohen, E. (2014). Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design.Implementation Science,9(1), 1. Chatchumni, M., Namvongprom, A., Eriksson, H., Mazaheri, M., Avdelningen Vrd och Omvrdnad, Rda Korsets Hgskola. (2016). Thai nurses experiences of post-operative pain assessment and its influence on pain management decisions.BMC Nursing,15doi:10.1186/s12912-016-0136-8 Hudson, B. F., Ogden, J., Whiteley, M. S. (2015). Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery.European Journal of Pain,19(10), 1447-1455. Joshi, G. P., Schug, S. A., Kehlet, H. (2014). Procedure-specific pain management and outcome strategies.Best Practice Research Clinical Anaesthesiology,28(2), 191-201. Kuusniemi, K., Pyhi, R. (2016). Present-day challenges and future solutions in postoperative pain management: results from PainForum 2014.Journal of pain research,9, 25. Magidy, M., Warrn-Stomberg, M., Bjers, K., Sahlgrenska Academy, University of Gothenburg, Gteborgs universitet, . . . Institute of Health and Care Sciences. (2015). Assessment of post-operative pain management among acutely and electively admitted patients - a swedish ward perspective.Journal of Evaluation in Clinical Practice,Epub ahead of print Meissner, W., Coluzzi, F., Fletcher, D., Huygen, F., Morlion, B., Neugebauer, E., ... Pergolizzi, J. (2015). Improving the management of post-operative acute pain: priorities for change.Current Medical Research and Opinion,31(11), 2131-2143.