Running head: FINAL SUMMARY REPORT

Final Summary Report

Vera Nixon
Bon Secours Memorial School of Nursing
Synthesis of Nursing Practice
NUR 4242
Ms. Wendi Liverman
October 30, 2016
Honor Code, I pledge
Final Summary Report
Pain assessments, including reassessments, are an important part of
nursing, correlating to vital signs. As such, efficient pain reassessments are
crucial, specifically within the hour of an intervention, in order to further
pursue the need for more interventions (Twycross, 2010).
The assessment of pain, with effective reassessments, are directly related to
Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) scores in relation to how well the nursing staff has been able to
control a patients pain (Hospital Consumer Assessment of Healthcare

Providers and Systems [HCAHPS], 2015). A quality improvement project was

developed in order to attempt to improve the pediatric floors pain
reassessments.
Timely pain reassessment is an important part of every nursing
assessment of a patient. On the pediatric floor, the issue of timely pain
reassessments, specifically within an hour of intervention for pain, is a
constant struggle. Directly related to patient outcomes, if evaluations of the
efficacy of pain interventions arent assessed in a timely manner, patient
outcomes may decline, even to the effect of prolonging hospitalization or
even leading to readmissions once discharged. Evidence has demonstrated
that in such patients as postoperative pediatric patients, lack of pain control
has led to an increased risk of complications, longer hospitalizations, and
longer recover periods (Campbell, 2013). This is further related to HCAHPS
scores, even though it is not nationally reported for pediatrics, as it is
compiled for the unit to how often the pain was well controlled, and if
everything was done by the staff to help with the pain (HCAHPS, 2015). The
combination of unit collected data related to low consistency of
reassessments within the hour and poor HCAHPS scores related to pain, point
to an area in which improvements can be made.
As a result, an improvement project to increase the consistency of pain
reassessments for patients with pain interventions was developed. To this
effect, a cause and effect diagram was developed to investigate if any steps
could be taken to improve the reassessments of pain (Cause & Effect

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Diagram). Once causes were discovered, a lack of visual reminders was

identified as an area in which improvements could be made. There was
discussion and attempted creation of new visual reminders that could be
placed on each WOW in the patient rooms for the nurses, or other staff
members, to remind them to reassess by a certain time to discuss pain with
the patient. Creation and implementation of new physical reminders were
unable to be designed and placed within the allotted time, in addition to
developing education to the new reminders. As time constraints limited the
implementation of new reminders, previously used reminders were rediscovered and reattached to the WOWs in each patient room. Staff
members were personally re-educated on use of the reminders in order to
remind the nurse to reassess.
Discussion with my mentor for the project directed me towards another
staff member who regularly does random chart audits every month to assess
the assessment and reassessment of pain of patients. My mentor directed
me to this staff member to retrieve her audits prior to and after
implementation of the audits. Certain predictions were made immediately
prior to, as well as during, implementation of the project. Four predictions,
that nurses are not reassessing pain at all, that nurses are reassessing pain
but not within the hour post-interventions, that PCTs were attempting to
obtain pain reassessments but not within the hour of an intervention, and
that PCTs were reassessing pain within the hour after an intervention, were
anticipated. During the implementation phase, information from the

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previously collected chart audits were investigated, which in turn developed

into a barrier.
The pain audits collected were unfortunately not as detailed as
anticipated as evidenced by the predictions made for the project. The chart
audits disclosed the following, and nothing more: age and gender of patient,
number of pain assessments of the last twenty-four hours of the patient, if
the patient did/did not have pain during assessment, pain scale used for pain
assessment, type of pain of the patient, if an intervention was use and if so
what kind of intervention, and if the pain was reassessed. Unfortunately
there was no way to effectively assess the timeliness of the assessment and
reassessment of the patient from the collected audits.
Overall the improvement project was a failure in my part due to the
ineffective audits both prior and post implementation of the project. During
the project, I discovered that in order for any improvement project to be
effective related to pain reassessments, it truly requires a long-term project,
at least six months, to effectively measure the success or failure of an
improvement project. A specific assessment for pain reassessments directly
related to the project should have been developed in order to effectively
measure the area in which improvements could be made. I should have
made the predictions based on audits that I had developed prior to the
beginning of the semester, and therefore were done prior to the beginning of
starting the project, so I would have had some more pertinent background
information related to the instances I actually wanted to look at. Therefore, I

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could have then re-audited doing the same people with similar patients to
evaluate if the process of the reminder actually reminded people to reassess
pain in the hour post intervention.
The staff were receptive to the re-education, as it pertained to my
project. I was able to gather information to why the reminders didnt appear
to work the first time they were implemented, and therefore attempted to
implement changes, such as reminders the shifts I worked and made the
reminder a bit more eye-catching. I further attempted to follow-up with the
staff to see if the reminder was helping, and if not, why. This project ended
up being more of an informational gathering project, ending up teaching how
to successfully implement a project. Through this quality improvement
project, improvements were made, to myself when attempting another
project, rather than to the unit. The errors that were made, as well as the
obvious failures, taught me how to more effectively develop a project. I
would like to truly implement a project with my own developed audit chart,
which I could do on a weekly basis, to truly follow the trend, either poor or
good, in which the pain reassessments are trending. I would intentionally
then educate the PCTs to the fact that they could reassess, or even assess,
pain when entering a patients room, as it is part of collecting vital signs,
which is within a PCTs scope of practice.

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6
References

Campbell, F. (2013). Improving postoperative pain outcomes for children

[PowerPoint slides]. Retrieved from Centre for Pediatric Pain Research:
International Forum on Pediatric Pain (IFPP): http://pediatric-pain.ca/wpcontent/uploads/2013/04/Campbell_WHITEPOINT-SLIDES.pdf
Hospital Consumer Assessment of Healthcare Providers and Systems. (2015).
HCAHPS Survey. Retrieved from
http://www.hcahpsonline.org/files/HCAHPS%20V10.0%20Appendix
%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)
%20March%202015.pdf
Twycross, A. (2010). Managing pain in children: where to from here? Journal
of Clinical Nursing, 19, 2090-2099. http://dx.doi.org/10.1111/j.13652702.2010.03271.x