Using Timed Visual Reminders to Improve Pain Reassessment and Documentation

Problem/background: Pain is one of the primary reasons to seek medical care in the general population. Effective pain management is essential to facilitate the progression of a patient’s condition and recovery, shorten the length of hospital stay, promote quality of life, and reduce healthcare expenditures. In the fiscal year 2022, the completion of pain reassessment documentation was 38% at the current clinical site, a neuro intermediate care unit (neuro IMC) at a large tertiary care inner-city hospital. Published evidence shows that timed visual reminders in the electronic health record (EHR) and standardized staff education increase the frequency of timely pain reassessment.

Purpose/significance: The purpose of this DNP project is to improve the rate of pain reassessment and documentation within 60 minutes after PRN oral pain medication administration to 100% by using timed visual reminders within EPIC over 15 weeks in fall 2023 on the neuro IMC.

Methods: The planned intervention is to implement timed visual reminders in EPIC that pain reassessment must occur within 60 minutes after administration of oral pain medication. The staff RN logs in to the designated department in EPIC and selects the assigned patient. Timed visual reminders in EPIC automatically pop up after oral PRN pain medication administration. The project leader’s (PL) strategy to promote staff RN adherence includes obtaining formal written commitments from key partners for accountability, gaining staff buy-in by altered incentive structures, preparing champions to keep communication open with one-to-one meetings per request basis and shift huddles at 7 AM and 7 PM twice weekly to discuss project progress, sharing a summary of weekly chart audit data reports with staff and the nurse manager who is the project’s clinical service representative (CSR), and setting up online classes and in-person educational sessions during week one of the project. The PL conducts weekly chart audits to determine the frequency of pain reassessment and documentation within 60 minutes of post-PRN oral pain medication administration. The PL performs weekly chart audits and enters data (medical record number, completion of pain reassessment documentation within 60 minutes) into REDcap, a HIPAA-compliant database. The PL transforms these data into run charts to identify patterns and measure adherence over the 15 weeks. The PL performs a post-survey of staff RNs during week 15 regarding response to a visual reminder tool within EPIC.

Preliminary results: The project measures the number of times nurses completed pain reassessment within 60 minutes per total number of times nurses gave oral pain medications. During project weeks 1-6, RNs completed 352 oral pain medication administrations. 72% of RNs completed pain reassessment documentation within 60 minutes of administration of oral pain medication administration.

Preliminary conclusions: Three weeks of preliminary data indicate that timed visual reminders within EPIC improve pain reassessment and timeliness of documentation rate by at least 72%.