IMPROVEMENT TOOLS

Csilla Orban Bonacci

Discussion Main Post

I believe pain management is something patient really will use to score a unit or hospital. I have experienced this lately as a nurse. A patient believed she was not taken seriously by her doctor for the pain she was having and she called just about everyone higher above the doctor in leadership to complain. She called the Vice President of the hospital and left him a message, called her aunt in another state to ask her to call the hospital, too, called Patient Satisfaction, and the charge nurse. Within an hour she received flowers, chocolates and all the medicines she wanted. We did all this just to have a patient satisfied. In cases like this it is our tendency to judge and say these patients just want their "drugs", but then another patient in a few days who we would consider not "drug-seeking" had a complaint that a nurse did not take her pain seriously. Patients want to feel painless. They want their pain medicine around the clock and without constantly having to contact their nurses to bring it. I learned a lot from these situations. I learned not to question patient's pain. I was particularly amazed how the person who works as a Patient Satisfaction staff member catered to her every need and went around asking everyone involved in her care what is happening. That patient got everyone's attention for a few days she was there. Everyone was on their toes. 

Looking at the strategies and interventions that were applied in the scenario above to improve patient satisfaction scores I believe the unit is on the right track, but there are gaps between reminders such as  of a few months before they introduce an another tool or strategy such as a lecture, a post on the wall, assessment etc. , yearly verification of data ( it should be more often than that),  annual lecture on pain management in the elderly should be at least twice a year, etc. I believe consistency is needed to remind staff about our goal to manage pain and obtain better scores, and also follow up on their documentation is key every day until it becomes natural to document ( Spath, 2018). I mention this because I have seen in hospitals a lot of documentation on pain missing. 

But still this is not enough to obtain patient satisfaction. Patients are not interested in our documentation but their pain being managed. Aging brings about a lot of aches and groans and the elderly do like to have their pain managed so I do believe that this unit is right when it comes to having a geriatric unit pain is really the 5th vital sign that needs to be on our minds as nurses. According to a study however it was shown that patient satisfaction when it comes to pain was higher when pain medication was brought within less than 30 minutes once they asked for it and it was lowest when it took a provider longer than 30 minutes to bring it ( Tawil et. al, 2018). I believe therefore a lecture on instructing nurses to bring pain medication to patient in less than 30 minutes would be satisfactory.  Also patient satisfaction was really low when it came to pain due to fear of getting addicted to these medications. Some patients would rather be in pain than take some of the prescribed medications for fear of getting addicted. They would prefer a different medicine that manages their pain ( Tawil et. al, 2018). In this case having the provider ease their mind by giving them information on medications would help. or offering an alternative medicine.

Although the team claimed victory on patient satisfaction there is still room for improvement when it comes to surveys. Many patients do not fill out surveys (Schöpf et. al, 2019) and therefore the scores can be skewed with only 25% response rate. An accurate score you get from more than 25%.  It has been shown patients rate their satisfaction also higher if interviewed directly instead of surveyed ( Schöpf et. al, 2019). Our hospital does offer surveys however Patient Satisfaction personnel comes room to room and asks questions about patient being content and if something is off he addresses it immediately. I personally believe that if we deal with it right there on the spot it works better than waiting for patients to go home and then fill out a survey. It has been shown if patients wait longer to fill out a survey it is most likely going to be a negative comment (Schöpf et. al, 2019).

Staff participation is another thing that is lacking on this unit. At this rate the strategies are not sustainable and most likely patient satisfaction will tumble. Incentives or if not even penalties should be suggested for non-compliance of pain documentation and giving patient pain medicine in less than 30 minutes unless it truly is not possible. 

References

Schöpf AC, Vach W, Jakob M, Saxer F. Routine patient surveys: Patients' preferences and information gained by healthcare providers. PLoS One. 2019 Aug 1;14(8):e0220495. doi: 10.1371/journal.pone.0220495. PMID: 31369612; PMCID: PMC6675389.

Spath, P. (2018).  Introduction to healthcare quality management (3rd ed.). Health Administration Press.

Tawil S, Iskandar K, Salameh P. Pain management in hospitals: patients' satisfaction and related barriers. Pharm Pract (Granada). 2018 Jul-Sep;16(3):1268. doi: 10.18549/PharmPract.2018.03.1268. Epub 2018 Sep 25. PMID: 30416629; PMCID: PMC6207353.