Mary Manning Walsh Home (MMWH) embraced the opportunity to enhance their Quality Improvement program by joining the select group of New York nursing homes participating in the Nursing Home Quality Initiative (NHQI).
Utilizing the NHQI Quality Improvement Tool Kit, MMWH focused on two Quality Measures: Post Acute Pain and Chronic Pain.
Following guidelines for developing successful Continuous Quality Improvement programs, MMWH created an interdisciplinary team involving administration, department heads, unit staff nurses, and certified nursing assistants.
Utilizing the policies and procedures checklist, the facility polled staff about their understanding of pain management policies and documenting findings. After it was observed that front line staff were unfamiliar with the MDS and the impact of their daily clinical practice on the data source, staff were educated about coding for pain based on the resident's comfort level, rather than the level of treatment required to achieve comfort. Correct MDS coding was reviewed on a one-to-one basis with clinical staff, then spread via larger group in-service programs. In-service training focused on the importance of consistently coding to the resident's reported comfort levels, and not the strength of the medications given to treat the pain. In addition, the team created a new, one-page Pain Assessment tool that documents pain for cognitively impaired and cognitively intact residents.
To overcome the barrier of RN committee members frequently missing meetings, meetings were moved to the unit.
In addition to a Palliative Care program in which all staff are encouraged to participate, MMWH developed educational programs on methods to provide comfort and pain management. The Palliative Care Specialist reports enthusiastic physician involvement and awareness, indicated by an increase in requests for pain evaluations, including requests from the psychiatrist.
MMWH has begun utilizing data tracking tools for concurrent chart review, first for pain, then for pressure ulcers and restraints.
MMWH's Post Acute Pain Quality Measure improved from 26% in 2002Q2 to 7% in 2004Q1; their Chronic Pain Quality Measure numbers, though low to start (7% at 2002Q2) declined to 1% in 2004Q1.