Congress Abstracts 2006

12

AN EXPLORATION OF PAIN MANAGEMENT IN ACUTE CARE MEDICINE PATIENTS. Sandra Vannice, RN, MSN, OCN^®, AOCN^®, and Catherine Dingley, PhD(c), RN, FNP, Denver Health Medical Center, Denver, CO.

Despite the availability of effective therapies, pain continues to be identified as a major concern in oncology. The Oncology Nursing Society has identified pain as a cancer symptom that is sensitive to nursing interventions. This project focused on pain management in adult patients at a 398 bed academic public safety net hospital. Nursing staff on two acute care medical floors expressed concern regarding pain management in their patient population that includes cancer among other diagnoses. Patient satisfaction survey results related to pain management underscored these concerns.

The purpose of this project was to describe nurses' knowledge and attitudes related to pain management, explore the pain management practices of physicians and nurses, and identify educational needs that could serve as a foundation for further provider interventions.

To determine pain management practices, 215 audits were conducted on charts during a three-week period in late 2004 using the Medical Record Pain Management Audit Tool (McCaffery, 1999). Nursing staff completed the Nurses' Knowledge and Attitudes Survey Regarding Pain (McCaffery & Ferrell, 1995) as well as the RN Needs Assessment: Pain Management Tool developed by the University of Wisconsin.

The data revealed a snapshot in time of pain management. Nurses were more likely to document pain assessments and to use the 0-10 pain rating scale than physicians. PRN opioids were ordered most frequently for pain management. Pain was assessed and documented prior to receiving medication less than 50% of time and pain level was assessed and documented after receiving medication only 25% of the time. Staff learning needs and significant gaps in nursing knowledge of pain management were identified. The project results revealed inconsistent documentation of pain assessment and pain scores by both nursing and physician staff.

This project revealed the need for interdisciplinary education related to appropriate pain assessment and management using both pharmacologic and nonpharmacologic interventions. Additionally, diffusion of evidence-based practices was limited, indicating a need for further provider interventions, exploring the establishment a pain champion model. Implementation of a collaborative multidisciplinary approach to pain management is anticipated to result in improved patient outcomes and satisfaction.