An interdisciplinary process for improving pain management in oncology.

Abstract

182 Background: Upcoming changes in Medicare reimbursement models take into account HCAHP scores, and over the next 1-3 years, penalties will be enacted towards those institutions falling below a standard on their publicly available HCAHP scores. The HCAHP pain domain can be one of the most challenging to impact directly due to lack of pain management knowledge, proper assessment skills, expertise in managing complex pain syndromes, and the heterogeneity of pain symptomatology reported by advanced cancer patients. Methods: This project identified inpatient oncology units with suboptimal HCAHP scores. The objective was to improve HCAHP pain scores to > 90th percentile. Nursing intervention focused on five primary areas: a) A requirement to attend a mandatory class on malignant pain management; b) making available nursing pain mentors; c) a requirement to address pain during rounds with physicians; d) priority access to medications to address pain; and, e) encouraging event reporting for uncontrolled pain issues. Resident physicians were provided expectations for pain management and attended a mandatory class on malignant pain taught by a palliative medicine attending physician. A palliative medicine physician was also assigned to the unit to evaluate patients with pain scores > 6/10 or complex pain needs. An algorithm for pain control was designed to include a timeline for intervention as well as an escalation process for slow or inadequate physician response. A hand-off report was provided to the charge nurse by the senior resident physician at the end of each day that included a tentative plan for treating any escalating pain. Results: All initiatives were implemented in September 2012. By February 2013, Pain HCAHP scores increased 10% over the entire Taussig Cancer Institute, and increased 20% for the solid tumor oncology unit. This placed all units who received this targeted intervention above the 90th percentile as compared to other hospitals on the HCAHPS pain score. Conclusions: A well-defined collaborative model between physicians and nursing produced measurable improvement in pain outcomes for oncology inpatients. An interdisciplinary approach is essential for the management of complex pain issues in an oncology patient population.