Bundling Interventions to Enhance Pain Care Quality (BITE Pain) in Medical Surgical Patients

Karen L Rice; Julie Castex; Margaret Redmond; Jeffrey Burton; Jia-Wen Guo; Susan L Beck

doi:10.31486/toj.18.0164

Bundling Interventions to Enhance Pain Care Quality (BITE Pain) in Medical Surgical Patients

Ochsner J. 2019 Summer;19(2):77-95. doi: 10.31486/toj.18.0164.

Authors

Karen L Rice¹, Julie Castex¹, Margaret Redmond², Jeffrey Burton³, Jia-Wen Guo⁴, Susan L Beck⁴

Affiliations

¹ Center for Nursing Research, Ochsner Clinic Foundation, New Orleans, LA.
² Palliative Medicine, Ochsner Clinic Foundation, New Orleans, LA.
³ Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA.
⁴ College of Nursing, University of Utah, Salt Lake City, UT.

Abstract

Background: Inadequate pain management and undertreatment remain a serious clinical issue among hospitalized adults, contributing to chronic pain syndromes and opioid dependency. Implementation of individual pain care interventions has been insufficient to improve pain care quality. The purpose of this interprofessional, patient-centered project was to implement a 6-component bundle of evidence-based pain management strategies to improve patients' perception of pain care quality and 24-hour pain experience outcomes. Methods: A quasi-experimental design was used to test the effect of a bundled pain management intervention on 3 medical surgical units. Baseline outcomes using the Pain Care Quality-Interdisciplinary (PainCQ-I^©) and Pain Care Quality-Nursing (PainCQ-N^©) surveys were measured monthly for 4 months preintervention and 30 months postintervention. Results: A convenience sample of 846 patients was analyzed. The effect of the intervention on pain outcomes could not be tested because unit-based adherence did not meet the goal of 80%. A subsample of 70.2% (594/846) of participants was sufficient to complete a 3-group analysis of preintervention and postintervention participants with confirmed intervention adherence. Participants in the postintervention group who received all 6 components (n=65) had significantly higher odds of higher PainCQ^© scores than those in the preintervention group (n=141) (PainCQ-I^©: odds ratio [OR] 2.61, 95% confidence interval [CI] 1.54-4.42; PainCQ-N^©: OR 3.82, 95% CI 2.06-7.09) or those in the postintervention group receiving ≤5 components (n=388) (PainCQ-I^©: OR 2.52, 95% CI 1.57-4.03; PainCQ-N^©: OR 3.84, 95% CI 2.17-6.80). Conclusion: Medical surgical patients participating in this study who received the bundled 6-component intervention reported significantly higher levels of perceived pain care quality, suggesting that a bundled approach may be more beneficial than unstandardized strategies.

Keywords: Acute pain; animal assisted therapy; aromatherapy; implementation science; interprofessional relations; music therapy; pain management; pain measurement; pain–postoperative; quality indicators–health care; quality of health care; surveys and questionnaires.