Doctor of Nursing Practice
Kerry A. Milner, DNSc, RN, EBP-CH
Andy Hernandez, BSN, RN
Significance and Background: Chronic pain assessment should focus on patients' functional status, quality of life (QOL), and pain control. A tool to assess pain intensity and biopsychosocial impacts of pain for patients with chronic pain was needed in a Federally Qualified Health Center (FQHC). The Defense and Veterans Pain Rating Scale (DVPRS) incorporates a numeric rating scale with four functional questions on pain interference on ADLs. DVPRS design stimulates communication between patients and providers about their pain, its impact on function, and state of mind. Treatments are focused on making the pain tolerable and optimizing patient function while avoiding unwanted side effects from medications. Convincing evidence supported the use of the DVPRS.
Purpose: Provide nursing and provider education on best practices for pain assessment and to implement the DVPRS in a FQHC. Track nurse adherence to using a new pain scale and providers treatment for chronic pain.
Methods: Plan-Do-Study-Act. Plan- DVPRS was added to pain policy in a FQHC. Do- DVPRS was presented to five providers and six nurses and practiced using the DVPRS and documenting the results. Study- data on DVPRS use in patients presenting with pain and their treatment plans. Act- present to stakeholders and plan for next PDSA cycle.
Outcome: There were 292 in-clinic, adult patient encounters with pain: chronic (46%), acute (21%), both (3%), and unknown (31%). Sixteen patients were assessed for pain using the DVPRS. Nurse adherence to workflow for documentation was poor and inconsistent with fourteen (87.5%) patients who had at least one inconsistency in their documentation. Barriers to provide on-site support and feedback led to poor adherence and process errors. Seventy-seven percent of patients assessed with the DVPRS, and a pain diagnosis received either referrals and/or new non-opioid medication prescriptions.
Discussion: Despite low nurse adherence, DVPRS education, use and purpose informs providers’ plan of care. Adopting a brief comprehensive pain assessment tool (e.g., DVPRS) in a primary care setting will improve provider and patient communication surrounding pain, assess impacts of pain on function and QOL while eliminating opioid prescriptions with alternative therapies.
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Zhang, J. (2022). Pain assessment policy update and nursing education on best practices for pain assessment: A quality improvement project [Unpublished DNP project]. Sacred Heart University.