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Institutionalizing Effective Pain Management Practices

Practice Change Programs to improve the quality of pain management in small health care organizations

The State Pain Initiatives (SPIs) implemented the Practice Change Programs in several steps:

Recruitment of facilities: The SPIs sent a recruitment packet to the facilities in the geographic area they were targeting. The administrator and director of nursing signed a letter of commitment to join the program, and agreed to form an organizational team of 2-3 staff that would participate in the educational conferences and develop and implement a pain quality improvement workplan.

Site visit: The coordinator of the SPI program visited each facility that signed a commitment form and worked with the organizational team to complete a Structural Assessment. In addition, the coordinator taught the teams to use a Random Numbers Table to select residents/patients to approach to respond to The One Minute Pain Questionnaire. The teams turned in 10 completed questionnaires at the 1st conference.

1st Educational Conference: The agenda and materials of this two-day conference were designed to provide the organizational teams with the rationale for the importance of making pain management an institutional priority, the principles of pain assessment and management, and the foundation for forming an work plan to improve pain management practices. The Resource Center (TRC) of the ASPI provided the templates for the conference handouts and presenters for the plenary sessions. The SPI provided all workshop leaders.

Consultation: In the five-month interval between the 1st and 2nd conferences, the SPI coordinator called the organizational teams monthly to offer encouragement and advice.

2nd Educational Conference: The agenda of the 2nd conference included a presentation on neuropathic pain, a poster presentation by each organizational team showcasing its quality improvement efforts, and additional content as requested by the participants of the 1st educational conferences. These varied from state to state, and included such topics as: Patients with a Substance Abuse History; Personality Styles, Illness and Pain; Pain Management in Patients with Cognitive Impairments; and Equianalgesic Dose Conversion (see Sample Agendas). The organizational teams also repeated the Structural Assessment and turned in a second set of patient questionnaires.

Data analysis and feedback: TRC obtained the necessary review and permissions to collect and analyze the program’s data from the University of Wisconsin-Madison Health Sciences Committee for the Protection of Human Subjects. The SPI coordinators collected data from the organizational teams and submitted that data to TRC. At the end of the program, TRC analyzed the data and provided individualized reports on the results of the structural assessment and the compiled patient questionnaires to each of the organizational teams.

Cost of model: The total cost of each program was approximately $50,000. Of this amount, $36,000 to $40,000 was allocated to the State Pain Initiative costs and the remainder to TRC costs.

 
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