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ED pain identification and treatment program thrives at Saint Barnabas

Monday November 26, 2012
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Pain management has become a priority for the nursing and medical staff in the ED at Saint Barnabas Medical Center in Livingston, N.J. The "got pain?" campaign aims to immediately determine whether a pain-related complaint exists, flag the patient record to alert all providers that immediate pain management is required and ultimately treat the pain utilizing both medication and non-medicinal strategies.

The future of healthcare reimbursement likely will be governed by value-based purchasing incentives, which are based on patient satisfaction scores resulting from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, known as HCAHPS.

"Based on current ED patient satisfaction surveys, we know that our patients place a great deal of emphasis on the assessment and treatment of their pain throughout their visit," said Doreen Dutchak, RN, MBA, CEN, director of emergency services at Saint Barnabas.

To inspire patient participation, all clinical ED staff wear red "got pain?" pins prominently on their uniforms. The pins serve as a visual cue and reinforce patient interaction with staff regarding pain reporting and treatment. All patients are also asked to describe any pain they are having during the triage process. Once a patient is experiencing pain, his or her status immediately is changed on the electronic tracking screen to "PAIN," and a treatment algorithm is initiated. This algorithm is designed to provide a framework for the documentation, initiation of nursing standing orders — such as acetaminophen/ibuprofen administration, topical cold-pack application, environmental modification, etc. — and physician notification.

The door-to-pain treatment goal is 30 minutes or less, even if the patient is in the waiting room. The initiative has resulted in a 25% decrease in response times based on a random patient chart survey. Pain management, along with other clinical and patient experience improvement strategies, has contributed to an independent patient satisfaction survey overall score higher than any recorded score over the previous four years, and a score more than five points higher compared to one year before."This ED is a great example of how teamwork that includes active engagement with patients and staff can help define a new standard of excellence in caring for patients coming to the ED," said Mary Ann Healy-Rodriguez, RN, PhD, assistant vice president of logistics and patient care services at the medical center.

David Gold, RN, is the transfer center coordinator at Saint Barnabas Medical Center.


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