Striving for Consistent Documentation of Pain Assessments, Patient Satisfaction

In the course of conducting routine monthly pain audits at their hospital, Tina Etzel, BSN, RN, and Gail Miswald, BSN, RN, CMSRN, noticed that assessment and reassessment documentation had been falling behind at the same time that patient satisfaction scores had been on the decline. Patient satisfaction was measured according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey metrics.

Etzel and Miswald, of Froedtert Hospital (Wauwatosa, Wisconsin), presented their experience with aiming to improve pain documentation compliance and patient satisfaction scores in a poster at the Oncology Nursing Society (ONS) 44th Annual Congress, held in Anaheim, California.

For a baseline, the team performed retrospective chart audits. Next, they began educating registered nurses on staff through monthly patient chart audits and information on posters and slides. They also provided feedback to staff, identifying areas of missing information, as well as areas of success.

The team eventually began more substantial audits, but they noticed no improvement in either documentation or patient satisfaction scores. The investigators tried re-educating staff and providing more reminders and information through various methods, including at staff meetings and via email. These methods also reached out to new staff members who had not been exposed to the first educational effort.

Following completion of the second educational effort with reminders, the team performed their final audit. At this point, documentation had again not improved. However, the process drove more communication between staff and patients regarding pain. Patient satisfaction scores had risen by this point, to above the hospital’s threshold.

Etzel and Miswald note that incomplete documentation could be attributed mostly to nurses not remembering to complete a sedation scale, but without it, the pain assessment was incomplete.

Novel innovations from this project was a laminated badge card for nurses that contained a reminder to assess pain, a patient education sheet specific to the unit and its commitment to pain management, and the patient education materials included in the hospital admission folder were updated..

Reference

Etzel T, Miswald G. Excellence in pain management: through assessment and reassessment. Poster presentation at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA.