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Running header: PDSA PROJECT

Amber Johnson

PDSA Final Project

December 8, 2010

Practicum
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Model for Improvement- Improving patient outcomes

1. What are we trying to accomplish? Improving patient outcomes and satisfaction through

proactive and timely pain management initiatives.

2. How will we know the change is an improvement? Overall improvement of patient

satisfaction scores, lower pain scale numbers during pain assessment on a 1-10 scoring,

and handed out patient survey

3. What changes can we make to result in an improvement? Increase in nurse and UAP

rounding to monitor pain assessment, medication, repositioning. Institute innovated non-

pharmacological pain relief measurements. Daily rounding of charge nurse to each

patient for own pain assessment. Institutes patient feedback methods such as surveys.

Plan- Improve patient outcomes and satisfaction through proactive and timely pain management
initiatives. Hourly pain assessment rounding, with the nurse and UAP taking every other hour.

During this they check patient’s measurement of pain, look for coming medication and provide

needed support. Nurse will document on patient boards the time of next availability of pain

medication. This will allow the patient to be able to request medications in advance and allow the

nurse time to gather medication and needed supplies for timely delivery of medications. Also

institute new innovative non-pharmacological pain relief methods such as (heat/cold application,

Distraction, Music therapy, massage, & guided imagery) in congruence with medication

administration. Nurse will Document pain numbers and interventions done in patient records.

Nurse will note times of inconsistencies or successes for a full review at the end of the specified

study time period. It is predicted that the required hourly pain assessments will allow for

intervention for pain management to be done before pain becomes to severe, improving patient

satisfaction with there hospital stay and improve patient outcomes by reducing pain it reduces

patients stress, improves mobility, allows for better eating and overall quicker recovery

Do- Hold and employee meeting to explain and discuss the new policies and procedures of pain
management. Provide needed training to nursing staff of safe implementation of non-
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pharmacological pain intervention. Have charge nurse do a daily round to each patient’s room

monitoring Nurse/UAP sign off sheet and soliciting feedback from patients. Charge nurse will

gather information on (What is your pain now on a 1-10? Did someone check on your pain status

throughout the day? Was your pain medication given in a timely manner from you requesting it).

Provide a short 10 question survey on patients overall satisfaction, how there pain was managed,

what Non- Pharmacological Intervention did they participate in and was it helpful, and if they feel

anything additional could help maintain there pain better)..

Study- Daily, hourly sign off sheets monitored and collected for 2 months allowing staff time to
obtain training and implement into daily practice. Charge nurse will monitor the sign off sheets

and handle any frequent discrepancies. It is not always possible for a nurse to get to every room

hourly, but if there are frequent bought of missing sign offs, additional training and coaching

would be provided at this time, Patient feedback surveys would be collected for 3 months. At the

end of the time frame the surveys will be reviewed and compared to patient satisfaction scores.

Data will be collected for the total time of 4 months (1 quarter). At this time the charge nurse will

speak with nurses, UAP and other assisted healthcare personnel on their thoughts, feelings and

suggestions at this time about the changed policies. Patient surveys, employee feedback, patient

satisfaction scores, patient pain assessment scores, and charge nurse notes will be analyzed and

compared to beginning predictions.

Act- At this time any needed changes to the new policies, survey and data collection process will
be made at which a new cycle of the study will begin with additional changes. With careful review

of the data from this cycle some changes may be made to the study. Many issues may arise

during after careful consideration of all the data presented in the study. Examples for this

study:#1-Out of 200 patients on the floor for the time period of the study cycle only 120 filled out

patient satisfaction survey. This can change the scoring of the data for 80 people who received

care suggestions and scores are not included. The charge nurse found several issues related to

this. First 40 people were of other nationalities and the survey only came in English. In the ACT
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phase for next study cycle more available prints of languages will be available. 2nd the other 40

people who did not receive surveys were moved from this floor to another and the nurses to not

realize they were to survey as well. In the ACT- An employee meeting was set up to discuss

which patients should be receiving the survey so next cycle the issues will not affect the outcome.

Examples #2- Through charge nurse rounds and patient surveys it has become apparent that

many patients did not partcipate in all of the Non- Pharm interventions offered by the nurses.

After careful assessment through ACT it had come up that patients declined the intervention

due to lack of knowledge about the intervention and that nurses busy did not provide it.

Through ACT with the next cycle NON- pharm intervention pamphlets will be made to

explain what it is and the benefit. It will be predicted for the next cycle this will increase the

use of NON-Pharm and decrease large amounts of pain meds given.

References-

Eloise, Carr. (2010). Advancing nursing practice in pain management. PA:

Blackwell Publishing

Kelly, P. (2008). Nursing leadership & management 2nd edition. Calumet:

Delmar Learning Systems

Okon, TR. Agency for Healthcare Research & Quality, (2009). Improved
pain resolution in hospitalized patients through targeting of pain
mismanagement (31-1039). Washington: PuBMED. Retrieved from
http://www.psnet.ahrq.gov/resource.aspx? ResourceID=9819