Strengthening the Pain Program in a Tertiary Care Hospital in India: A “Pain-free Hospital” Initiative

Background: Pain is a common issue in hospitals and can affect patients’ health and satisfaction. Various previous studies show that almost 50% of admitted patients report pain, with moderate-to-severe pain in up to 20% of the patients. A hospital-wide pain management policy is crucial to the early identification and optimal management of admitted patients in pain. Aims: The aim of the study was to strengthen the existing hospital pain management program. Settings and Designs: This quality improvement study (clinical audit) was conducted in a 250-bed tertiary care hospital in India over a period of 8 months. Materials and Methods: A preintervention audit was done to assess compliance to correct pain monitoring standards and delivery of initial analgesic within 30 min of pain escalation for Numeric Rating Score >7 (turnaround time [TAT] <30 min). A survey to assess nursing knowledge about pain management was also conducted. Over the next 3 months, multiple corrective interventions were implemented. This was followed by a postintervention audit of the same parameters. Statistical Analysis Used: A Fishbone analysis was done to determine the various factors contributing to poor compliance with standards. Accordingly, a driver diagram was designed to improve the pain program at our hospital. Results and Conclusion: Successful interventions were implemented, which led to significant improvement in correct pain monitoring standards (52.8% to 98.6%), timely escalation of pain score >7 to the pain management team (PMT), and timely delivery of initial analgesic within 30 min (63.8% to 89.9%). This was directly related to the improvement in nursing knowledge and training (62.7%–85.5%). This shows that creating a “pain-free” hospital requires the implementation of well-thought-out pain management policies and procedures and comprehensive training of nursing staff.