Congress Abstracts 2004

35

ALIGNING PAIN REASSESSMENT PRACTICES WITH EVIDENCE-BASED PRACTICE GUIDELINES THROUGH USE OF A RESEARCH UTILIZATION APPROACH. Cynthia Smith Idell, BA, RN, MSN, AOCN^®, Marcia Grant, RN, DNSc, FAAN, OCN^®, Michelle Rhiner, RN, MSN, NP, Neal Slatkin, MD, Robin Gemmill, RN, MSN, CS, and Ellen Siegmund, OTR, City of Hope National Medical Center, Duarte, CA.

Failure to assess and document pain is cited as a common etiology of pain under-treatment. Barriers to reliable and valid pain assessment include variations in assessment, nurses’ attitudes, and documentation. NCCN practice guidelines cite reassessment as a critical component of pain management, yet implementation of this standard of care challenges nursing staff. Effective programs enhancing pain assessment and documentation advocate professional education and research utilization partnerships between clinicians and nurse researchers.

The purpose of this project is to improve inpatient nursing pain reassessment practices at an NCI-designated cancer center adopting Level IIA evidence-based practice guidelines through an interdisciplinary research utilization approach. Historic staff competency data demonstrated sub-optimal levels of pain reassessment and documentation, occurring less than 50% of the time. Aggregated competency trends validated the need for change in staff practice. Desired practice change aligned nursing pain reassessment with NCCN pain guidelines through adaptation of literature-based strategies promoting reassessment. Project design employed a conceptual framework for organizational change, the CURN research utilization model.

Interventions included baseline practice evaluation, interdisciplinary team formation, literature review and best practice critique, force-field analysis, piloting strategies designed to improve reassessment (e.g., unit-based pain rounds, one-on-one performance feedback, red-flagging patients for proactive management), and extension of innovations house wide.

Clinical, staff, and organizational outcomes were measured by retrospective chart audits of staff documentation (assessment/reassessment) in pilot units receiving interventions and comparing them to control units (N = 250), administration of staff Pain and Knowledge Attitudes Surveys pre- and post-interventions, referrals to pain service, and patient satisfaction score trending. Statistical analysis was conducted using relational database, descriptive statistics, and matched t-tests.

A well-designed research utilization approach enhances pain management through careful selection of strategies to improve pain reassessment. Other healthcare providers may adopt this research utilization approach to create superior patient care outcomes, to improve nursing pain practice, and to increase compliance with NCCN pain guidelines.