Purpose: The purpose of this interprofessional, patient-centered project was to implement a unit-based 6-component evidence-based pain management bundle (PAIN-X Therapy) to improve medical-surgical patients’ perception of pain care quality, 24-hour pain experience outcomes, and opioid usage.
Background/significance: Pain in the United States is a public health crisis. Inadequate and undertreatment of pain among hospitalized adults potentially contributes to chronic pain syndromes and opioid dependency. There is some evidence to support a benefit in pain care quality associated with using a bundle that includes non-pharmacologic options. Pain care bundling 1) actively engages patients as a treatment partner, 2) applies complementary and conceptually aligned components, and 3) improves patients’ ability to cope with pain.
Method(s): A quasi-experimental design was used to test whether PAIN-X therapy on 1 acute surgical unit (intervention) vs. usual care on 1 trauma surgical unit (control) improved: patients’ perception of pain care quality (PainCQ-I© & PainCQ-N©); 24-hour pain experience outcomes (average pain, time in severe pain, medication administration
frequency, % pain relief, ability to cope with pain), and monthly unit opioid usage. Outcomes were measured each week using a convenience sample of eligible patients (on unit >24-hours, >18 years, acute pain, active opioid order). Unit characteristics (% BSN, RN experience, skill mix, FTEs, RN:patient ratio, RN-HPPD, RN productive
hours, combined patient days, and opioid usage were collected monthly.
Results: Data from 127 (intervention, n=59; control, n=68) consented participants were included in this 6-month interim analyses (age M=44.79, Mdn=44, IQR=34-57). Differences in mean monthly unit staffing characteristics included 75% BSNs on intervention, 61% on control; 2.1 years’ experience on intervention, 3.7 on control; and 16.33 FTEs on intervention, 22.4 on control. No group differences (p>0.05) identified between groups for participant characteristics (age, sex, race, ethnicity, marital status, education, chronic pain, opioid naive). No differences (p>0.05) between groups for pain care quality: PainCQ-I© (α=0.66; intervention M=3.94, SD=1.24; control M=4.31, SD=1.03) or PainCQ-N© (α=0.92; intervention M=5.00, SD=0.95; control M=5.11, SD=1.01). Three 24-hour pain experience outcomes had significant between group differences: pain medication administration frequency, % pain relief, and ability to cope with pain. Control reported receiving pain medication significantly more often (26-50% of the time, 63/68 [92.7%] than intervention (37/59 [62.7%], Fisher exact, p=0.0002, two-tailed). Intervention reported a significant increase in 1) % relief from pain medication (M=65.4%, Mdn=70, IQR=50-80; U=4438, n1=68, n2=59, p=0.0012, two-tailed) vs. control (M=51.47%, Mdn=23.13, IQR=40-70) and 2) ability to cope with pain (M=7.49,
SD=2.75) vs. control (M=6.32, SD=2.49), (U=4377, n1=68, n2=59, p=0.0032). Unit-based opioid oral milligram morphine equivalent (MME) usage reflected the intervention (M=34,935.83) unit used 6.63% more MME than control (M=32,694.89).
Conclusions/implications: Intervention group participants did not perceive an increase in pain care quality compared to those in the control group. However, intervention group participants reported a higher % relief from pain medications and an increased ability to cope with pain than the control group. Continuation of the study is warranted to test the causal link between PAIN-X therapy and pain-related outcomes, including the impact of intervention fidelity and confounding variables such as unit staffing characteristics.