Innovation in Hospital Quality Improvement Activities—Acute Postoperative Pain Management (APOP) Self-Help Toolkit Audits as an Example

Abstract

It is often difficult to maintain quality improvement change. Many behavioral strategies have been used to improve uptake of new practices and knowledge. One effective way of changing medication prescribing is audit and feedback with specific educational feedback. The challenge however is to maintain ongoing quality improvement activities. In Australia, unique downloadable "toolkits" are now available to assist hospitals to maintain prescribing quality improvement activities. The first designed to improve the management of acute postoperative pain (APOP toolkit) has been piloted. The toolkit includes data collection and educational tools, an automated feedback report on key indicators, with complete instructions for use. The APOP toolkit has been used in 73 hospitals, in two facilitated "snapshot" audits. There was continued improvement in performance, assessed by increases in the percentage of patients with measured pain and sedation scores and in those with documented pain management plans at discharge, compared with earlier APOP project audits. Using this example of the APOP toolkit and "snapshot" audits, we have now demonstrated that hospitals nationwide are able to undertake quality improvement activities voluntarily to maintain optimal performance. Encouragement, guidance, and availability of ready-made tools developed by a national team facilitate opportunities for ongoing quality improvements.

The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review

“…Among all of the toolkits, 20 were developed for a specific disease context, 21 22 26–28 31–34 40–45 47 51 54 55 57 most commonly for cancer (n=8) 27 28 31 40 41 43 54 57 and diabetes (n=3). 22 26 51 The remaining toolkits were developed for disease prevention (n=5), 23 38 46 52 58 infection prevention (n=2), 11 53 postoperative pain (n=1), 48 smoking cessation (n=1), 49 care in the geriatric population (n=8), 24 25 29 30 35 36 39 56 patient safety (n=1) 50 and general hospital quality improvement (n=1). 37 …”

“…Toolkits were targeted to health professionals (n=29), 11 21 23–27 29–32 35 37–39 42 44–47 49–52 53 55–58 patients (n=10) 21 22 28 33 34 40 41 43 48 54 and caregivers (n=1). 36 In one study, the intervention included separate toolkits for primary care physicians and patients.…”

Exploratory study of sleeping patterns in children admitted to hospital

“…The current exploratory study has provided a foundation for further studies including further exploration of relationships between single rooms and the child's and parent's perspectives. This ‘snapshot’ of sleeping patterns of hospital inpatients can provide baseline data to evaluate educational interventions (medical or nursing) to improve hospital‐related sleep as has been used for post‐operative pain . For example, increasing hospital staff awareness of the importance of sleep may lead to fewer unnecessary interruptions of sleep from room entries and exits by staff members …”

Quality Pain Management in Adult Hospitalized Patients: A Concept Evaluation

“…Advancing quality science and the quality of care is dependent on measurement. Integral to the QPM concept is the quality circle where outcomes are monitored and feedback provided to practitioners or institutions (Pulver, Oliver, & Tett, ). Measuring outcomes is a recommended practice to improve quality (TJC, ) and has been found to improve practice (Pulver et al., ).…”

“…Figure depicts the concept of QPM according to this concept evaluation. The main difference between the models in Figure and Table (the characteristics of QOM according to the Donabedian model) is that Figure incorporates the quality cycle (Pulver et al., ) and shows the relationship among structure, process, and outcomes. Furthermore, it takes into account how QPM is embedded in the six aims of quality services recommended by the Institute of Medicine ().…”