September, 1999

Pain Management Quality Assurance Program Launched at University of Maryland Medical Systems (UMMS), Baltimore, Maryland.

"Timing is everything," says Karen Kaiser, RN, MS, Clinical Practice Coordinator, in reference to the timeliness of a recent JCAHO (Joint Commission for Accreditation of Healthcare Organizations) visit in helping her sell the idea of a pain quality management program. Although JCAHO's new pain standards are not yet integrated into the survey process, JCAHO representatives are already asking questions. The newly released JCAHO standards related to pain management represent an opportunity for Pain Champions to garner administrative support for their pain initiatives.

Just after the JCAHO visit, Karen presented a fact sheet describing the proposed JCAHO standards, and graphs showing what could be done to integrate them into the CQI process. The content of the presentation was ready long before the visit, but, given competing priorities, focusing attention on the development of an institution-wide pain quality initiative was difficult. The JCAHO surveyors' attention to the topic provided the perfect opportunity to lobby for presenting the highlights of the new standards to the Performance Improvement Committee, with a demonstration of how it could be implemented. The time was right for advancing the initiative. "We had been successful with several population-based improvement initiatives, but implementing a wide-scale quality initiative had not been tried at our 700-bed institution. By presenting the information to key people on the heels of the JCAHO review, we were able to capitalize on the heightened awareness that surrounds a visit!" says Karen.

Shortly after the visit, the formal proposal was presented to the Performance Improvement Committee at UMMS, which is made up of top-level management staff responsible for setting the direction for institution-wide quality initiatives. As a result of the lobbying efforts mentioned above and a recognition of the need for more robust information, the Abbott's Total Pain Quality Management (TPQM)© program will be implemented and a committee established to assume responsibility for the initiative. This group will report directly to the Performance Improvement Committee. Real-time information about pain scores, interference with functional status, patient education, type of therapy, satisfaction with therapy, and side effects, will be collected by specially trained volunteers.

"Although we have been collecting some data on the degree to which pain interfered with daily life post-discharge and retrospective information about satisfaction with pain management during the hospital stay, we were concerned that we were missing a lot of information on how well we were doing from the patient's perspective at the time of his or her stay, the time period we are most concerned about," says Karen.

In response to why trained volunteers will collect the data, Karen notes two main reasons: "Primarily, we want to be sure that patients feel free to respond truthfully without fear that responses will affect their care. Second, and almost as important, is our concern for staff time in the fast-paced, limited-resource environment of today's acute care setting. We needed to be creative in our approach."

The data collection and analysis will be ongoing. Results will be shared with practitioners and will serve as a springboard to discuss further improvements in pain management.

Last Updated: January 5, 2001