Data document a high prevalence of pain among Veterans receiving care in VHA Polytrauma Rehabilitation Centers (PRCs), but routine conduction of pain assessments is lacking. The availability of brief, reliable tools for documenting assessments of pain treatment should lead to improvement in overall pain care. To fill this gap, a Computerized Patient Record System (CPRS) tool designed to record comprehensive pain assessments has been developed for use throughout the VHA including the PRCs.
This implementation and formative evaluation project tested the feasibility and perceived value of the use of the CPRS pain template. The project involved implementation of the CPRS pain assessment tool at two PRC sites, education and training of participating provider and nursing staff in the use of the tools, and ongoing qualitative and quantitative evaluation of the implementation process.
Twice monthly teleconferences between study personnel and PRC staff allowed for the development of an implementation and data collection plan and identification and training of study champions. Site visits were conducted to provide hands on training with the template and to refine the implementation plan. Followup teleconferences to support the implementation process were held.
Despite extensive pre-visit planning and the high prevalence of pain among PRC patients, template adoption was low. At both sites, physicians expressed reluctance to use the template due to time concerns and a desire to continue using their personal templates. Nurses were considerably more receptive to the template though other barriers emerged, such as partial overlap with the newly developed national nursing assessment template.
Future efforts to implement electronic pain assessment tools should anticipate and address the site and discipline specific challenges identified in this study. Where similar electronic tools are already in use, it may be best to encourage revisions to the existing tools rather than wholesale substitution. Collaboration with other VACO program offices to obtain buy in about the importance of adopting a standardized approach to pain assessment is also indicated.
- Rosenberger PH, Kerns R, Jokl P, Ickovics JR. Mood and attitude predict pain outcomes following arthroscopic knee surgery. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2009 Feb 1; 37(1):70-6.