Joanne G. Samuels

Abstracting pain management documentation from the electronic medical record: comparison of three hospitals.

BACKGROUND Pain management science results are derived from research conducted using medical record. APPROACH This article describes methodological issues arising from abstracting pain management documentation (PMD) from the electronic medical record in three hospitals. After approval, PMD data were collected from the patients history and physical, discharge summary, operative care notes, computerized nursing flow sheets, progress notes, and medication records. RESULTS Each acute care facility required a different approach to abstract data. Inconsistent documentation in pain management assessments, interventions, and reassessments were identified across hospitals. DISCUSSION Inconsistencies pose measurement threats and hinder benchmarking efforts. Work to standardize PMD across propriety computer systems is warranted.

The Impact of Assessment and Reassessment Documentation on the Trajectory of Postoperative Pain Severity: A Pilot Study

Comparing organizational approaches to pain management is warranted to understand best practices and provide decision makers with evidence on which to base resource intensive documentation policy decisions. To provide this evidence, a multilevel modeling (MLM) approach is required to accommodate the interrelatedness and nested nature of pain management factors affecting outcomes. Along with MLM, the widespread adoption of the electronic record provides an ability to capitalize on the repeated measurement benefit of the current pain management documentation output by using pain severity trajectory (PST) as a precise and clinically relevant outcome of interest. Therefore, the purpose of this pilot study was to examine the methodological issues that arise when conducting MLM research aimed to answer the question: what is the impact of assessment and reassessment documentation routines on postoperative pain severity trajectory? Researchers used timed pain management documentation data output to construct a growth model of a patients PST and performed a two-level analysis from a convenience sample of 3 hospitals and 146 patients. Analyses revealed that the hospital where care occurred, the type of surgical procedure, and the presence of reassessment documentation within one hour of intervention affected the PST. Pilot work showed that pain management documentation output could be reformulated into research variables for hypothesis testing. The presentation of the reassessment data output posed a measurement limitation. An interdisciplinary research team is needed to adequately compare organizational practices. Basing policies on evidence has the potential to improve pain management care.

Development of the Samuels Scale to Rate Pain Management Documentation

Charting deficits and nominal-level data create difficulties when rating pain management documentation (PMD) quality. Researchers developed an interval level rating scale using Q-methodology. Pain entries (340), sorted into patterns, were rank ordered by nine pain management experts and distributed across a 7-point scale. Rankings demonstrated agreement (intraclass correlation coefficient = .96). One factor explained 77.19% of the variance. Reliability and validity were supported. Interval level data enable more robust testing of interventions to improve PMD outcomes.

Using the Electronic Health Record in Nursing Research: Challenges and Opportunities

Changes in the patient record from the paper to the electronic health record format present challenges and opportunities for the nurse researcher. Current use of data from the electronic health record is in a state of flux. Novel data analytic techniques and massive data sets provide new opportunities for nursing science. Realization of a strong electronic data output future relies on meeting challenges of system use and operability, data presentation, and privacy. Nurse researchers need to rethink aspects of proposal development. Joining ongoing national efforts aimed at creating usable data output is encouraged as a means to affect system design. Working to address challenges and embrace opportunities will help grow the science in a way that answers important patient care questions.

The Application of High-Reliability Theory to Promote Pain Management

Evidence-based pain management, a high-volume hospital service, impacts resource utilization and quality indicators. Despite extensive efforts to improve care, outcomes remain poor, and barriers seem insurmountable. Change management strategies that embrace organizational and individual accountabilities are warranted. Conceptualizing evidence-based pain management within the context of high-reliability theory may help redesign systems and processes to better meet needs of patients. The author discusses using a high-reliability framework as a change management strategy.

The Regulation of Dietary Supplements in the United States Advocating for a Reasonable Approach, Protecting Patient Safety, and the Role of Nursing

Many Americans report using dietary supplements (DS) and there is evidence that the use of such products is increasing. Under the current regulatory system DS are not tested for safety or effectiveness, as with over the counter and prescription drugs, and the Food and Drug Administration (FDA) has limited authority to protect Americans from potential harm. DS in the United States have become a major public health and patient safety issue with injuries, illnesses, and deaths attributed to their use. Efforts in congress to legislate safer regulations have been met with limited success, in part because of the lobbying efforts of the DS industry. Although there is near consensus in the literature and among stakeholder government agencies that a modified FDA role is needed, resolving the issue requires a multifaceted approach. Along with political and legislative action, effort must be made to increase the American public’s knowledge of DS.

Analyzing variability in pain management using electronic health record data.

Variability in pain management processes may affect outcomes. Researchers collected pain management documentation from electronic health record systems of 3 hospitals and constructed process and outcome variables. Simple linear regressions revealed that relationships exist between increased pain variability and less frequent assessment and more frequent intervention, identifying targeted areas for improvement. Researchers demonstrated the use of the electronic record output for improvement purposes.