Improving pain management in the internal ward by Implementing an educational process and developing a pain management protocol
Ben-Sasson M. (MD), Schiff E. (MD), Haglili O., Levy I. (MD) Attias S. (MPH), Vulfsons S. (MD)
Pain management in the internal ward is a common problem, which arises from different diagnosis and sometimes stand by its own as a chronic pain syndrome. The approach to pain management is divided into 2 important steps. Step 1 is the evaluation & documentation of the pain. Step 2 in managing the painful patient by understanding its pain mechanism while providing the correct treatment in order to reduce it.
Recent studies had shown that the evaluation and documentation by the medical staff was inaccurate and tended to demark the level of pain reported by patients. The physicians suffered from lack of knowledge and misconceptions regarding to pain management and medication, specifically the use of opioids. Therefore patients in the internal wards were not properly evaluated and are mistreated for pain relief.
Assessing & Improving the pain management knowledge, skill & Abilities (KSA) for internal ward physicians with the assimilation of an up-to-date pain management protocol.
This was a prospective study. An educational program which covers major aspects of pain management in the internal ward & a pain relief protocol were introduced. The research examined 11 physicians from an Internal medicine department for a period of 3 months. During this period the physicians undergo the curriculum. A KSA questioners regarding pain management were performed before and after the course. Data of pain medicine prescribed to the ward, before & after the educational program, had been gathered.
There was a significant improvement in the overall satisfaction of the physicians regarding to pain relief management in the Ward (4.16 to 2.57 p.value = 0.003) on a 1 to 6 (1-Definetly agree, 6-Definitely disagree) Likert scale analysis. Prior to the intervention, in the modified KP50 questionnaire, the average score for all physicians was 60.9 with a median of 61. After the intervention, there was a significant improvement with an average score increased to 70.2 with a median of 73.3 (p.value = 0.012). The change from baseline presented by the median, reflex that the improvement occurred due to an increase of scores by most of the physicians. Post intervention was an increase of 9% in total opioid administration, though the total morphine equivalents (mg) given per patient with mod-severe pain was decreased by 19% ((552.9mg to 445.5mg). Possibly reflecting a better tailored opioid management in this subgroup of patients. An increase of almost 20% in the prescription of laxatives was observed post intervention. That increase was more than twice higher than the elevation in opioid administration, reflecting better consideration of opioid induced constipation
The overall satisfaction & knowledge of the department’s physicians was significantly improved following the educational process as a first and critical step in improving the pain relief management. Pattern of Opioid & laxatives prescription were modified, reflecting adherence to the pain management protocol and to the educational module. An educational program regarding pain relief is feasible & positively changes the pain management in the internal ward.