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BACKGROUND/RATIONALE:
Available data document a high prevalence and severity of pain among veterans receiving care in VHA Polytrauma Rehabilitation Centers (PRCs). Observational data and informal feedback from the PRCs suggest that routine conduct of pain assessments that are deemed necessary for the development of optimal pain care plans is lacking. The availability of brief, reliable tools for prompting and documenting such assessments and for conducting ongoing reassessments of pain treatment efficacy should lead to improvement in overall pain care and provide the opportunity for the development of a comprehensive database on the experience of pain among veterans in these Centers. To fill this gap, a Computerized Patient Record System (CPRS) tool designed to prompt and record comprehensive pain assessments has been developed for use throughout the VHA including the PRCs.
OBJECTIVE(S):
This proposed implementation and formative evaluation project is designed to test the feasibility and perceived value of the use of the CPRS pain template and accompanying health factor reports derived from the assessments in two PRC implementation sites. The project is conceived as involving a collaboration between the PI and his investigative team, the Polytrauma/Blast-Related Injury QuERI, and the PRC implementation sites. The project will involve several iterative steps involving implementation of the CPRS pain assessment tool at two PRC implementation sites, intensive initial and ongoing 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.
Data analysis will focus on assessment of support for continued use of the tool in the implementation sites and further dissemination of the tool in the remaining two PRC sites. A secondary objective is to take the first necessary steps to develop a standardized pain database related to veterans in these settings.
METHODS:
The initial steps in the study included obtaining IRB approval at the two implementation sites and conducting twice monthly teleconferences between study personnel and implementation site staff. Teleconferences allowed for the development of an implementation and data collection plan with end users and identification and training of study champions. Implementation site visits were conducted to provide hands on training with the pain assessment reminder and to refine the implementation plan. Additional teleconferences have been held to support the implementation process and to collect qualitative feedback from the participants at these sites. Study personnel and local clinical application coordinators have developed and attached health factors to the pain template reminder and the reminder has been integrated into existing staff templates. Health factor reports and qualitative feedback from end users will be collected and analyzed to assess reminder template usage.
FINDINGS/RESULTS:
Formal outcome data regarding use of the pain template and template satisfaction are currently being collected. We have completed both site visits. health factors have recently been added to the pain template reminder. The health factors are consistent across study sites. This will allow us to obtain consistent data about the template and the patient population across sites. No usage data have been analyzed.
IMPACT:
Ultimately, it is believed that implementation and evaluation of the feasibility and utility of the CPRS pain assessments tool will have direct implications for improving pain care for veterans with severe polytrauma.
PUBLICATIONS:
None at this time.
DRA:
Military and Environmental Exposures
DRE:
Diagnosis and Prognosis, Rehabilitation, Quality of Care
Keywords:
Pain, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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