Purpose: As healthcare focus shifts from the hospital environment to ambulatory care, collaboration among leaders is essential. The volume of patients in ambulatory clinics is growing and the care nurses are providing is becoming more complex. When an ambulatory care system employs a staff development specialist (SDS) and a clinical nurse specialist (CNS), it makes sense for these leaders to collaborate to improve quality of care, yet minimal literature exists to demonstrate the impact of the SDS/CNS collaboration on the ambulatory care enterprise. The purpose of this quality improvement project was to evaluate the SDS/CNS collaboration through the use of the PLAN-DO-STUDY-ACT model to improve quality and carry out change related to the use of pain score assessment in a large ambulatory care system.
Description: PLAN: Joint Commission requires accredited ambulatory care organizations to use defined criteria to assess pain and our organization’s policy requires a baseline pain assessment is completed upon each initial contact with an ambulatory care patient. Our internal accreditation team audits identified a gap in care. Upon further investigation by the SDS/CNS, only 13.5% of patients were assessed for pain upon each initial contact in January 2021. We developed a plan to address this gap and presented our plan to the ambulatory care shared governance council and incorporated education into ambulatory care clinical orientation. We developed and completed an attestation form for all clinical staff, documenting understanding of the pain policy which was completed by May 31. To aid in pain assessment, a tool was developed and distributed in the form of a pocket card. Follow-up emails and discussions with data were sent monthly to ambulatory care leadership to reiterate compliance.
DO: The above plan was implemented as indicated.
Evaluation/outcome: STUDY: Our baseline rate of pain assessment in January 2021 was 13.5%. By March, it was 18.91%, and by April, it was 26.76%. At the end of May 2021, it was 35.32%. Within this brief time frame, 2.4 times more patients are now being assessed compared to baseline, indicating significant improvement resulting from this collaborative quality improvement project.
ACT: Data is ongoing. The organization transitioned to a new EHR (Epic) starting June 5. We intensely educated clinical staff on how to document the pain score in the new EHR system through hands on education and visual workflows to further enhance compliance.