May 12, 2000

Chisari presents
his pain manual.

On March 22, MGH staff simultaneously measured the pain level of all inpatients and some outpatients during the "Pain Pulse" — an initiative of the MGH Cares About Pain Relief Project. While some units performed well, the overall results of the Pain Pulse show that the MGH still has much work to do to improve the pain treatment of patients.

Patients were surveyed about the pain they were feeling at that very moment and then were asked to rank it on a scale of 1 (no pain) to 10 (the worst pain imaginable). Of the inpatients surveyed, 27 percent said they were feeling a level of 5 or greater and of the outpatients surveyed, 51 percent said they were feeling pain greater than a level 5. Literature states that any rating of 5 or above indicates a significant amount of pain and need for additional interventions.

"The MGH is leading the fight against pain, and we are the only hospital in the country that has done a Pain Pulse so far," says Heather Young, RN, project manager for the MGH Cares About Pain. "Although we still have much to do, we are on the right track to solving many of the problems hospitals have with managing patients’ pain."

To help with the issue of pain at the MGH, the MGH Cares About Pain project has offered a "Pain Champion" seminar twice to clinicians. The seminar is intended to give clinicians a forum for sharing stories and ideas, to teach clinicians about new techniques for treating pain, and to create advocates for pain on each unit. Several clinicians have reported making changes on their unit after participating in the seminar and have passed along their new knowledge to colleagues on their floors.

Gino Chisari, RN, a clinical nurse specialist on Bigelow 11, put together a manual about pain management for his unit to share information after taking the first pain champion seminar last fall. "The manual has information for staff nurses to use when they are faced with difficult decisions about pain assessment and intervention," says Chisari. "Awareness about pain management on our unit has been heightened, I think, partially because of increased verbal advocacy, as well as the implementation of the manual." Chisari says the manual is particularly useful because it contains the most up-to-date research.

The MGH Cares About Pain project also will implement a hospitalwide policy about assessment and management of pain. The policy will be helpful when clinicians have different points of view, and it will help with the documentation of assessment and relief of pain.

"Institutional change takes a long time," says Young. "I wasn’t surprised that we haven’t had drastic changes from last year, despite our efforts to advocate for pain relief. We have seen small improvements, and we are continuing to work toward the best pain management possible. That’s the most I could hope for."