A Systematic Assessment and Monitoring Intervention to Improve Pain Management and Quality Reporting Among Home Hospice Patients.

Abstract

Validated and reproducible means to systematically improve pain documentation and outcomes in home-based hospice populations are generally lacking. This article describes a novel electronic medical record (EMR)-embedded pain monitoring and management program for home-based hospice patients. Pain relief was measured by patients' self-defined pain within 48 hours of initiating care, recorded on a 0-10 pain scale. The Pain Continuous Quality Improvement Program consisted of EMR enhancements, staff engagement and training, and incentivizing techniques. The Pain Continuous Quality Improvement Program effectively improved documentation of pain and reduced the prevalence of unresolved problematic pain (e.g., lower average pain score ratings, decrease in patients reporting problematic pain after 48 hours of initiating care). Integrating the upgraded EMR system into routine practice and workflow was critical to facilitating rapid recognition of escalating pain and inadequate pain management as well as allowing improving monitoring of patient outcomes and staff performance.