Improving reassessment and documentation of pain management.

BACKGROUND The Joint Commission standards on pain management address the documentation of assessment and reassessment. Yet, little has been published to describe when and how nurses perform and communicate reassessment of pain. In 2005, the University of Wisconsin Hospital & Clinics (UWHC) was inconsistently reassessing pain after interventions, and documented reassessments were primarily confined to pain-intensity ratings. PLAN-DO-CHECK-ACT: A large-scale plan-do-check-act (PDCA) cycle was implemented to improve the documentation of pain reassessments, including development of an evidence-based administrative policy, repetitive education efforts with bedside coaching, changes in daily bedside documentation flow sheets, and audit and feedback. RESULTS From May 29, 2006, through July 16, 2008, a cumulative rate of 94.9% appropriately documented pain reassessments was achieved. DISCUSSION Despite implementation of an evidence-based policy to clarify requirements for pain reassessment, repetitive educational efforts, changes in daily bedside flow sheets, direct and extensive leadership involvement in the form of continuous bedside coaching, combined with more timely and persistent audit and feedback and clear accountability and alignment with goals, was necessary for substantial change. Strategies to sustain improvements include daily administrative and monthly staff documentation audits with prompt feedback to clinical nurse managers and staff. Nurses are instructed on the importance of pain reassessments and on the policy and specific documentation requirements. Reassessment of pain is a routine variable displayed on unit and departmental quality dashboards. Further study should examine if the intensity of this requirement for pain reassessment documentation ultimately facilitates the safety and effectiveness of pain management.