Biggest challenge:
“Our biggest issue was inconsistency from staff member to staff member in how they assessed pain and how they documented pain,” said Gary Kienbaum.

He said the entire team needed to be re-educated to explain to patients how to describe their pain on a scale of 0-10.

For example, if a patient states a pain level of 3 but is clearly uncomfortable, the nurse would then want to ask them more questions to get the patient’s true comfort and pain level.

Advice to other teams:
Involve other stakeholders: The PACU also involved the pre-admission unit.

“These are the nurses who ask the patients the questions before they come to surgery. We wanted to make sure these nurses were educated on the questions we were asking,” Ravida Benjamin said.

Side benefits:
Patient satisfaction: “We want to keep asking the patients what their tolerable level is and make sure that the documentation shows that the patients’ pain levels are tolerable, which will increase the patient satisfaction,” said Benjamin. 

Compliance: The PACU team also found that almost 80 percent of nurses had complied with the new assessments and documentation of pain levels, a strong baseline from which to measure the effects of pain management re-education.   

Background:
The PACU treats patients recovering from surgery and other procedures, and is usually the point of discharge. The goal is to send patients home with their pain levels as low as possible or under proper management with medicines and other treatments such as therapy. 

The team, reviewing patient charts, found that the same patient had widely varying levels of pain recorded by different nurses in a short period of time. They felt that this variation undermined the patient’s treatment, comfort level, and satisfaction. 

“We want to make sure these patients were getting properly medicated,” Benjamin said. 

The first small test of change involved devising a standardized set of questions for the nurses to ask – and document – regarding patient pain. Once nurses were complying at a high level in the recovery unit, the team moved on to another test of change: involving the pre-admission unit. 

Patients themselves were also educated on pain level questions before surgery, with cards and descriptions of the 0 to 10 pain scale. 

“Often when you have general anesthesia, it’s not a good time to be teaching patients on pain management,” Benjamin said. “We felt that before they went into the procedure, they should understand what the recovery room nurses would be asking them.”