• R Sean Morrison, Diane E Meier, Daniel Fischberg, Carlton Moore, Howard Degenholtz, Ann Litke, Catherine Maroney-Galin, and Albert L Siu.
• Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA. sean.morrison@mssm.edu
• Arch Intern Med. 2006 May 8; 166 (9): 103310391033-9.

BackgroundPain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management.MethodsThis controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing.ResultsUnits using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores.ConclusionsA clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics.

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