- Having adequate nurse staffing is integral to pain management and patient satisfaction, according to a group of researchers from the Connell School of Nursing at Boston College.
The study, published in the journal Pain Management Nursing, assessed patient satisfaction and pain management scores in a series of HCAHPS surveys in Massachusetts, New York, and California.
The research team, led by Connell School of Nursing associate professor Judith Shindul-Rothschild, assessed satisfaction and patient perception of pain management within the context of staffing levels for nurses, hospitalists, physicians, and residents.
The analysis showed that patient perceptions of better pain management were tied with higher levels of nurse and hospitalist staffing. Perceptions of pain management suffered when there were high levels of resident staffing.
The researchers also identified four predictors that led patients to report that their pain was poorly managed:
- Patients did not receive help as soon as they needed
- Poor nursing communication
- Poor medication education
- Receiving care in a teaching hospital
Those four factors indicate that better care coordination and cohesion amongst a care team are integral for patients to perceive their pain as well-managed. Nurses play a critical role in care coordination, the researchers pointed out, and higher nursing staff numbers can thus lead to better pain management.
“The findings highlight the need for adequate numbers of nursing staff to achieve optimal patient satisfaction with pain management,” Shindul-Rothschild said in a statement. “In addition, having a prescriber (physician or nurse practitioner) available 24/7 to offer continuity of care is essential."
Additionally, these findings suggest healthcare organizations drive better nursing and clinical staff communication, as well as provide support to resident clinicians. Health IT and secure messaging tools can help to connect medical professionals within a facility.
Industry experts advise driving better patient-provider communications to improve care coordination and continuity of care. Clinical leaders can also consult with other providers within the organization to determine gaps in care coordination. Understanding these lapses can help identify improvement areas within a specific organization.
Pain management has long been viewed as an integral piece of the patient satisfaction puzzle, said Shindul-Rothschild. As healthcare professionals grow wary of relying too heavily on pain management drugs such as opioids, it will be important that clinicians do all they can to drive patient perceptions of adequate pain management during patient-provider interactions.
"Given the opioid crisis, pain management is front and center in health care today," Shindul-Rothschild noted. "We need to think very critically of how we are managing pain, how we are communicating with patients, and how members of treatment teams are communicating with each other."
Other healthcare entities have been grappling with how to reconcile imperatives for patient satisfaction, pain management, and responsible opioid prescribing. Ensuring the patient is comfortable and not in unreasonable pain is an important part of driving patient satisfaction and a positive patient experience.
However, wanting a good patient experience should not lead to overprescribing of opioids, some experts have said.
HHS has already begun addressing this issue. In November 2016, the agency removed pain management measures from HCAHPS surveys. HHS argued that pain management questions compelled clinicians to overprescribe opioids because HCAHPS informs some value-based reimbursements.
“While there is no empirical evidence of such an effect, we are finalizing the removal of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey for purposes of the Hospital Value-Based Purchasing Program to eliminate any financial pressure clinicians may feel to overprescribe medications,” HHS wrote in a public statement.
Pain management should remain an integral part of patient care, HHS added. Patient and family caregiver satisfaction often hinges on responsible pain management.
HHS plans to develop better measures, potentially including provider communication, to determine responsible pain management as it relates to the patient experience.