Improving Quality of Care Through Pain Management

Improving Quality of Care Through Pain ManagementPatrick BobstA Qualitative StudyQuantitative research involves testing hypotheses, making predictions, subscribeing specific variables, collecting numbers and statistics, identifying statistical relationships, and making observations under controlled conditions (Johnson Christensen, 2008). None of the aforementioned(prenominal) attri providedes appear in chapter 17 Improving the quality of care through torment assessment and heed. Hence. this chapter written byWells, Pasero, McCaffery, (2008) is a detailed deductive qualitative analysis which aims to increase opportunities to develop empirically supported ideas and theories with applicable relevance in the field of smart worry for healthcare practitioners. Unlike inductive analysis, intention when not enough former experience about a phenomenon is known, deductive content analysis is used when the structure of analysis is initiated based on forward knowledge and with the int ent to test a theory(Elos Helvi, 2008). The authors of chapter 17 provided qualitative research by take ining the issue of pain control as a on the whole without immersion into variables. They defined the purpose of the study by subjectively understanding and interpreting interactions with words, identifying patterns and themes, and making observations of occurrences in a natural environment(Johnson Christensen, 2008). Qualitative research is much concerned with describing social meaning and therefore provides the flexibility to follow ideas and explore processes(McGonigle Mastrian, 2012).Research ProblemThe level of pain a patient experiences is emerging as the fifth vital sign in health assessments statuses (Ju-Ling Wen-Chu, 2013). Pain is a common occurrence and an expectation in hospitalized patients especially during the bearoperative period until now despite the availability of analgesics along with national guidelines to manage pain a disconnect remains in in proper pain management resulting in undertreatment for about 50% of patients with moderate to severe pain(Wells et al., 2008). Inadequately managed pain can lead to an arsenal of negative adverse physical and psychological outcomes including immune corpse suppression resulting in infections and poor healing, sympathetic activation causing cardiac ischemia and ileus, reducing mobility resulting in deep vein thrombosis, as well as pulmonary embolus, or pneumonia(Nwachukwu, 2012). All mentioned adverse conditions carry along the potential consequence of extending a patients length of stay in the hospital decreasing patient satisfaction and increasing organizational costs(Nwachukwu, 2012). The Affordable Care Act of 2010 has established changes in the way hospitals are reimbursed for services. Value-based purchasing has come to the read/write head in the healthcare industry with the centers for Medicare and Medicaid services (CMS) withholding full reimbursements for poor quality care or ev en nonpayment for patients readmitted within 30 days. moo patient satisfaction score indicators being tracked by CMS will not only affect an organizations bottom line but also stand to lose its reputation(Wells et al., 2008). When pain is not managed properly through an organizations pain management policy and procedure guideline the full(a) collaborative team responsible for managing a patients pain may be liable for legal action(Wells et al., 2008).Research Translated Into PracticeThe Agency for healthcare Research and Quality (AHRQ) focuses on current issues, patient safety and quality of healthcare providing practitioners the best research for optimal patient outcomes. AHRQ is an active participant in pushing consequence forward into practice with its Translating Research Into Practice (TRIP) initiative to generate knowledge about distinguish-based care and with the TRIP-II initiative the focus is on utilizing schooling technology to affect translational research and healt h policy (McGonigle Mastrian, 2012). The TRIP database is a clinical search engine designed to identify juicy-quality clinical bear witness for clinical practice that utilizes contextual issues such(prenominal) as the magnitude of the health issue, economic costs of the problem, the reliability, relevance, and validity of the data along with the quality and consistency of the register (Glasgow Emmons, 2007). The authors in the pain assessment and pain management research study utilized the TRIP database probing for the terms pain assessment and pain management in the literature search, filtered only the English language and publications dated within the last 10 eld, meta-analysis, practice guidelines, literature reviews, clinical trials, and random clinical trials (RCT). To use evidence in practice, the validity of research is evaluated on an evidential pecking order that is defined and the value is assigned to the information source on a scale of measurement from 1 to 6, on e being the highest evidence from a systemic review and six being the evidence from the opinion of experts(McGonigle Mastrian, 2012). The evidence table provided by the authors in the pain assessment and pain management study exhibits excellent research validity with multiple design types rating high on the evidential hierarchy scale listing. The authors utilized evidence from a meta-analysis study (Level 1), twelve RCT studies (Level 2), seven systematic literature reviews (Level 5), three literature reviews (Level 6), and one qualitative massage study (Level 7)(Melnyk Fineout-Overholt, 2011). The RCT is considered the most reliable source of evidence in the hierarchy and the meta-analysis is the best quality evidence because it uses a multiple individual research studies to come to a consensus (McGonigle Mastrian, 2012).Practice ImplicationsThe implications of this TRIP intervention designed to increase the use of evidence-based practice (EBP) in pain assessment and management highlights scientific evidence for practitioners to augment their clinical decision-making. Recommendations for successful implementation of pain assessment and management include education, the utilization of appropriate tools in pain assessment, a multimodal analgesic approach, continuous evaluation, and an established organizational pain management guideline. Patient and family education has been a central recommendation regarding pain management prior to any surgical procedure in that cosmopolitan pain evaluations can uncover patients attitudes, beliefs, level of knowledge, and unrealistic expectations that can be addressed(Wells et al., 2008). Wells et al. (2008) found that frequent communication, shared goals, and shared knowledge in education contributed to better pain outcomes. The most critical aspect of proper pain management is assessing pain levels on a regular tush using a standard format, and in order to meet the patients needs pain should be reassessed after each in tervention evaluating the effectuate and determining whether modification is needed(Wells et al., 2008). Based upon systematic reviews of pain quality amelioratement studies the emphasis has shifted from processes to outcomes where clinicians recognize and treat pain promptly, involve patients and families in pain management plans, adjust pain management plans as needed, and monitor processes and outcomes(Wells et al., 2008). Utilizing a multimodal approach for pain management is recommended which includes opioids, and non-opioids such as nonsteroidal anti-inflammatory drugs, and adjunct medications such as anticonvulsants can improve the safety of the therapy (Wells et al., 2008). With safety issues regarding the use of morphine, hydromorphone, and fentyal clinicians need to be educated about safe pain management to help proscribe undertreatment of pain and the resulting harmful effects. A series of systematic reviews indicate poor results and outcomes using the intramuscular rou te (IM) administering of an opioid analgesic (Wells et al., 2008). The IM route is painful, has an unreliable absorption measure and can be dangerous since patients are often alone at the time of peak affect and can become excessively sedated, vomit, and aspiratenevertheless produces the poorest outcomes (Wells et al., 2008). Unfortunately,Wells et al. (2008) describe the evidence for nondrug techniques of pain management including relaxation, music, massage, heat and cold therapies are neither supportive nor consistent, are considered weak in reducing acute pain, and may not improve outcomes. Ample evidence revealed the appropriate use of analgesics with the proper drug at the correct interval can provide good pain relief for the legal age of patients, and organizations should place their emphasis on improving assessments and administration techniques (Wells et al., 2008). The psychological, emotional, and financial toll of uncontrolled pain is monumental and everyone experiencin g discomfort because of pain justly expects and needs to play appropriate pain management.Research ImplicationsThe research provided supports the evidence-based treatments with analgesics in the management of pain, and appears to be effective in controlling acute pain. However, the undertreatment of acute pain remains general due to the clinician behaviors, which includes inadequate pain knowledge, assessment skills and administration of analgesics (Wells et al., 2008). Krenzischek, Wilson, Newhouse, Mamaril, Kane (2004) also assert a lack of pain management knowledge and the reduced usage of clinical practice guidelines is a high contributor in poor pain management. Research is needed for effective strategies in changing clinician attitudes and behaviors that will result in better pain management for patients as well as non-drug therapies (Wells et al., 2008). Wells et al. (2008) asserts, Lack of standardization of nondrug therapies is one of the drawbacks of the current literat ure (p. 11).Integration of InformaticsThe authors of this study integrated informatics through data, information and knowledge to support clinicians and patients in their decision-making regarding the best practices in accomplishing favorable outcomes and to improve the quality of care through pain assessment and management. Wells et al. (2008) utilized the informatics infrastructure to seek and manage validated studies from various sources, capture proper demographic, treatment and outcome information, and the AHRQ to share work out information, results, and insights. The informatics infrastructure is critical to EBP and promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than what is customary(McGonigle Mastrian, 2012). The paradigm of this is the way Ive done it for years is no longer acceptable and it is upon clinicians to apply the aforementioned viable knowledge, experience, understanding, and insight deri ved from EBP through informatics to gain and synthesize the effervescent wisdom needed for high quality patient care and optimal outcomes.ReferencesElos, S., Helvi, K. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. http//dx.doi.org/10.1111/j.1365-2648.2007.04569.xGlasgow, R., Emmons, K. (2007). 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Evidence-based practice in nursing and healthcare A guide to best practice (2nd ed.). Philadelphia, PA Lippincott, Williams and Wilkins.Nwachukwu, C. N. (2012). Decreasing pain and length of stay in the post anesthesia care unit (PACU) by implementing the ASPAN pain and comfort guidelines (Doctoral dissertation, The Catholic University of America). Retrieved from http//aladinrc.wrlc.org/bitstream/handle/1961/10269/Nwachukwu_cua_0043A_10311display.pdf?sequence=1Wells, N., Pasero, C., McCaffery, M. (2008). Improving the quality of care through pain assessment and management. Rockville, MD Agency for Healthcare Research and Quality.