Date of Graduation

Summer 8-9-2017

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino

Abstract

Abstract title: Improving Pain Management in the Cardiac Procedure Unit (CPU)

Unit: Cardiac Procedure Unit

Author: Marisol Aquino RN, BSN

Institution: University of San Francisco; Kaiser Permanente Nurse Scholars Academy; Kaiser Permanente Hospital, San Francisco (CNL practicum site).

Background Information

Cardiac Procedure Unit (CPU) specializes in the care of patients who are undergoing various cardiac procedures. The day-to-day operations are composed of Registered Nurses (RNs), Patient Care Technicians (PCTs), Unit Assistant (UA), and Nurse Practitioners (NPs) with an oversight from the Medical Director and Department Managers.

Patients’ perception of pain in the CPU has continually followed a “see-saw” pattern and averages at about 50% according to HCAPHS report. The nurse communication patient satisfaction score of the Cardiac Procedure Unit is below the target of 69%. Providing quality of care is the department’s top priority, so it is important for the nursing team to appropriately anticipate, assess and manage patients’ pain. The mission statement of CPU serves as a guide in providing the best possible cardiac service as CPU exists to consolidate the care of cardiac patients on one unit thereby increasing the experience of its members. “Our commitment is to provide compassionate care in a nurturing environment. We welcome your feedback and suggestions because not only do we care for you, we care about you.”

Global / Specific Aim

Project Aim: The goal of the project is to develop an effective pain management program for this microsystem. One of the key factors in accomplishing the goal is to improve nurse communication about the patient’s comfort level during care transitions such as Nurse Knowledge Exchange (NKE) and Authentic Hourly Rounding (AHV).

Global Aim: We aim to increase the pain management scores in the Cardiac Procedure Unit. The process begins with assessing why pain is not being identified and not treated accordingly. The process ends when pain management scores from the HCAPHS satisfaction survey using STAR rating system will improve from a baseline of 2 stars to 3 stars by December 2017.

Methods / Programs / Practices

The improvement theme for this project is based on the IHI’s quadruple aim: improved population health; reduce care cost; satisfied patients; satisfied providers. Lewin’s Change Model is a great framework to follow in order to guide practice change. The review of literature shows clear explanation that inadequate pain management reduces patient mobility, develops complications, increases length of hospital stay, and promotes poor patient satisfaction. The aim of this project is to organize a comprehensive pain education plan for the CPU staff. Quality improvement requires essential elements for success: fostering and sustaining a culture of change and safety, developing and clarifying an understanding of the problem, involving key stakeholders, testing change strategies, and continuous monitoring of performance and reporting of findings to sustain the change (Hughes, 2008).

Outcome data

Through effective communication between nurses, doctors and nurse practitioners in pursuing effective pain interventions, patient’s perception that pain was managed will increase as reported in the STAR ratings from HCAPHS survey. Better patient experience scores could indicate that a hospital has stronger teamwork, organizational leadership, and commitment to improvement, characteristics that could be associated with better quality measures and patient experience scores (Mehta, 2015).

Conclusion

Effective pain management results in better patient outcome and care experience, decreases length of hospital stay, creates cost saving for the hospital by increasing patient throughput and hospital capacity.

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