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Improving pain management practice. A medical center moves beyond education to document and manage patient care.

In 1993 nurses at Providence/ Portland Medical Center, Portland, OR, initiated a quality improvement project to assess pain levels in the facility's inpatients. A convenience sample in April 1993 showed an average pain intensity of 6.30 on a 0-10 scale (where O equals no pain and 10 is the worst pain imaginable). With the nursing administrator's support, pain management nurses presented a four-hour course in the basics of pain assessment and intervention to more than 850 nurses and 100 other professionals. In August 1993 nurses found that the intensity of patient pain had dropped to 5.70 on the 0-10 scale. Still dissatisfied with this situation, the nurses proceeded with a three-pronged approach to improve the medical center's quality of pain management: making the problem visible by better documentation and communication about pain; making an institutional commitment to pain management, including establishing pain management quality improvement as the medical center's first patient outcome institutional objective; eliciting the endorsement of influential committees. In August 1994 a random sample revealed patient pain had decreased to 3.21. The next step focused on empowering patients and families through education (e.g., revising the booklet on patient rights and responsibilities, posting signs in rooms encouraging patients to report pain) and clearing up myths and misconceptions through inservices and posters. A sampling in November 1995 showed that the average pain intensity of inpatients had been reduced to 2.32. Plans for continuous quality improvement interventions will further enhance patient comfort and recovery.