Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

[Citation: Spross, JA. Harnessing Power and Passion: Lessons from Pain Management Leaders and Literature. Innovations in End-of-Life Care, 2001;3(1), www.edc.org/lastacts]

Diagnostic Analysis: Questions for Institutional Self-Assessment

Strategic Dimension

• Is there an explicit institutional commitment to improving pain management? Is there evidence of this commitment and is the evidence strong (e.g., dedicated staff member, budgeted resources)?
• Is there sustained, visible support from key clinical and administrative leaders (e.g., CEOs, department directors, senior physicians, nurse administrators and managers?
• Is your setting accredited by organizations that have pain management standards (such as JCAHO)?
• Is pain management recognized as a potential risk management issue?
• Is pain management recognized as a potential financial risk?

Structural Dimension

• Is there an interdisciplinary work group to address pain management?
• Are there policies and procedures for pain assessment and treatment?
• Are there existing committees with clout that can lend support to your pain management improvement effort (e.g., Pharmacy and Therapeutics, Risk Management)?
• Do annual mandatory classes include the topic of pain management (similar to CPR or infection control)?
• Does the formulary include an adequate range (types and routes of administration) of medications for treating pain (e.g., nonopioids/NSAIDS, opioids, co-analgesics)?
• Are there resources for implementing nonpharmacologic interventions (tape players, relaxation and music tapes, hot and cold packs, etc.)?

Technical Dimension

• Has the question of which staff can perform what pain management activities been clearly defined? For example, is there a list of observations CNAs are taught to report? Are there nondrug interventions CNAs can perform under the supervision of nurses?
• Is pain management an emphasis in orientation, inservice education, and continuing education?
• Do staff need to demonstrate their competence in pain management periodically?

• Are physicians (who round less frequently in nursing homes) up to date on the LTC setting's pain management efforts?

Cultural Dimension

• Does the interdisciplinary pain management committee function well? Are communications within the committee, between committee and administrators, between committee and clinician effective and respectful? Is there evidence of commitment, i.e., do committee members show up, follow through on activities?
• Has a "power analysis" been done, i.e., has the team identified the influential others who will support or resist the institutional change?
• Have all staff with patient contact (not just clinical staff, but housekeepers, volunteers) been recruited into the pain improvement effort? Does this group include informal leaders as well as those in positions of influence?
• Is there an "internal marketing" plan for promoting the message that "Pain can be Relieved"?
• Is there a plan to acknowledge and celebrate progress?