Improving Patient Satisfaction With Pain Management in Multidisciplinary Radiation Oncology Setting

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Nurse-led project at an urban outpatient radiation oncology center not only achieved improved patient satisfaction regarding pain management.
Nurse-led project at an urban outpatient radiation oncology center not only achieved improved patient satisfaction regarding pain management.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

Denver, CO — Pain management initiatives have a positive impact on patient satisfaction and that impact can be sustained with continuous re-education of staff and periodic monitoring for adherence to newly established standards, a report presented at the 2017 Oncology Nursing Society Annual Congress has shown.

Previous studies have shown that pain associated with cancer or cancer treatment is undertreated. With the impending change in the CMS payment system to a value-based model, clinical quality process of care and patient satisfaction measures such as Press Ganey (PG) score are likely to influence health care organizations' reimbursement.

In 2014, Adelina Cabrera, BSN, RN, OCN, and colleagues at New York University Langone Medical Center (NYULMC) initiated a multidisciplinary improvement project aimed at providing safe pain management in a timely manner in response to low PG scores. PG scores regarding pain management at the radiology center were 50%. The center sees approximately 2100 new patients annually.

The NYULMC team conducted a needs assessment and identified 2 areas that needed improvement: education and documentation. “Our goal was to create a long-lasting change within our department that would lead to a better patient experience,” said Cabrera.

The researchers developed an initiative that incorporated educating professional and supportive staffs, as well as patients and caregivers, about pain management guidelines from the World Health Organization and the medical center's standard of pain management.

A significant component of the project was for all staff to consistently ask patients about their pain at each visit using the Wong-Baker FACES Pain Rating Scale. The electronic medical record clinical templates were revised to include documentation of assessments and interventions. Randomized chart reviews and professional feedback were utilized to measure staff adherence to the initiative.

Patient education pamphlets on pain management were given to patients prior to their initial radiation treatment.

The initial research found that nurse assessment, intervention, and documentation of patients' pain increased from 36% to 93%; physician assessment scores increased from 24% to 88%. Patient satisfaction increased from 67% to 95%.

In the 2015-2016 evaluation, assessment, intervention, and documentation for nurses is 96%; for physicians, 86%; and patient satisfaction is 92%.

The NYULMC team report that the multidisciplinary team approach consistently prompted intervention for pain scores 4 or higher. They were able to sustain the improvement goals of their initial project over 3 years, making the project a new standard of care within the department. However, achievements can be lost in the standardize-do-study-act (SDSA) phase. Therefore, periodic re-education of nurses, LIPs, and frontline clinical staff is essential to reinforce the new standards, including quarterly audits of documentation and monthly report of PG scores.

“Pain management is not simply a regulatory issue, but a real life issue that directly and strongly impacts our patients' experience and lives,” concluded Cabrera.

Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.

REFERENCE

1. Oliveri M, Cabrera A, Gumbs K, Smith B. Sustaining patient satisfaction with pain management in an outpatient radiation oncology department: a multidisciplinary quality improvement approach. Oral presentation at: Oncology Nursing Society 42nd Annual Congress; May 4-7, 2017; Denver, CO.

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