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NP010 Pain Prevalence Among In-Hospital Patients
S445
CCCN Abstracts
major issues with transfer of patients from the operating room to intensive care and to the wards. The purpose of this presentation is to describe the process of implementation of lean principles on the surgical patient flow at this facility and share the results of this endeavor. Success factors included a team with representatives of all stakeholders in the patient flow. A value stream map method was used to diagram the current and preferred steps in the process of discharging the surgical patient. Redundant and wasteful steps were eliminated in order to streamline the process. Implementation challenges were addressed and revisions made in the constant evaluation process. The outcome of this project improved patient flow, increased patient satisfaction with care experienced and improved staff satisfaction. Currently our metrics indicate that 68% of cardiac surgical patients are discharged by 10:00 am, a 30% improvement compared to prior to initiation of lean process.
NP010 PAIN PREVALENCE AMONG IN-HOSPITAL PATIENTS K Jabusch, B Lewthwaite, L Mandzuk, K Schnell-Hoehn, B Wheeler St. Boniface Hospital, Winnipeg, MB
Pain, both acute and chronic in nature is a widespread patient issue in all health care setting, including the cardiac population. Despite many improvement initiatives, inconsistent and inadequate pain management across all patient populations continues to be reported. Research links uncontrolled pain with potentially longer hospital stays, frequent post-discharge emergency room visits, early hospital readmissions, and lower patient and family satisfaction. Reflecting on the challenge of pain in providing cardiac care, this study investigates the prevalence of pain in a sample of patients on a single day in a Canadian tertiary care, urban hospital. This sample consists of in-hospital patients from various clinical programs including those on cardiology and cardiac surgery wards. The study goals are to provide a baseline measure of pain prevalence, and a benchmark for future quality improvement work. The Short Form-Brief Pain Inventory was the primary data collection instrument used to capture perceptions about pain severity and the degree to which pain interferes with feelings and daily functions. Using descriptive and inferential statistics, this presentation will review the study findings on pain frequency and the impact of pain on daily functioning. Gaining a better understanding of how admitted cardiac patients compare to others in different clinical programs will help guide the direction of cardiac nursing practice. As part of the review of implications for nursing practice for this study, this presentation will outline the role of nurses as the cornerstone of pain management during the assessment, delivery of pain relief strategies, and continuous evaluation of effectiveness of pain treatment.
NP011 CONTENT VALIDITY OF THE TORONTO PAIN MANAGEMENT INVENTORY-ACUTE CORONARY SYNDROME (ACS) VERSION S O’Keefe-McCarthy,1 M McGillion,1 S Nelson,1 S Clarke,2 J McFetridge-Durdle,3 J Watt-Watson1 1
University of Toronto, Toronto, ON, 2 University of Toronto, University Health Network, Toronto, ON, 3 Memorial University, St. John’s, NL
Pain arising from acute coronary syndromes (ACS) is severe and anxiety-provoking, which can potentiate myocardial damage. In rural settings, rapid access to cardiac catheterization (CATH) is problematic; ACS patients wait as long as 32 hours. In lieu of rapid CATH access, pain management should be optimal to prevent risk of deterioration and preserve vulnerable myocardial muscle. Evidence suggests that once ACS patients are stabilized, health care professionals (HCPs) do not adequately assess their cardiac pain. Clinicians lack of knowledge and problematic beliefs about pain may contribute to this problem. To date, no standardized tools are available to examine HCPs specific knowledge and beliefs about ACS pain that could inform future educational initiatives. The Toronto Pain Management Inventory was recently adapted to examine nurses knowledge about ACS pain assessment and management. OBJECTIVES/RESEARCH QUESTIONS: To examine content validity of the Toronto Pain Management Inventory-ACS version (TPMI-ACS), a measure designed to assess HCPs knowledge and beliefs of ACS pain assessment and management. METHODS: A survey design was implemented to determine the content validity index (CVI) of the TPMI-ACS version. Eight clinical and scientific experts rated the relevance of each item using a 4-point rating scale. A content validity index was computed for each item (CVI-I) as well as the overall scale using the Scale CVI Item Average approach (S-CVI/AVE); items with CVI-I ⬎ 0.7 were retained, items with CVI-I between 0.5-0.7 were revised/ clarified, and those with CVI-I ⬍ 0.5 were discarded. RESULTS: All 8 experts returned completed surveys yielding a 100% response rate. The CVI-I range across all items was 0.51.0. For 22 items, rated 3 or 4 only, the range was 0.75-1.0. Data indicated that the content of 22 of 25 items were deemed most relevant. One item was discarded based on consistent low relevancy ratings (i.e., 1 or 2). S-CVI/AVE was calculated for the 25-item TPMI-ACS draft as well as the revised 24-item scale, scores were 0.895 and 0.901 respectively, reflecting high inter-rater agreement across items. CONCLUSIONS: Preliminary content validity was established on the TPMI-ACS version. All items retained in the TPMI-ACS version met requirements for content validity. Further evaluation of the psychometric properties of the TPMI-ACS is needed to establish criterion and construct validity, as well as reliability indicators. BACKGROUND:
NP012 FASTRACK CARDIAC SURGERY C Kee, M Kroh, B Kiaii London Health Sciences Centre, London, ON
CCCN Abstracts
major issues with transfer of patients from the operating room to intensive care and to the wards. The purpose of this presentation is to describe the process of implementation of lean principles on the surgical patient flow at this facility and share the results of this endeavor. Success factors included a team with representatives of all stakeholders in the patient flow. A value stream map method was used to diagram the current and preferred steps in the process of discharging the surgical patient. Redundant and wasteful steps were eliminated in order to streamline the process. Implementation challenges were addressed and revisions made in the constant evaluation process. The outcome of this project improved patient flow, increased patient satisfaction with care experienced and improved staff satisfaction. Currently our metrics indicate that 68% of cardiac surgical patients are discharged by 10:00 am, a 30% improvement compared to prior to initiation of lean process.
NP010 PAIN PREVALENCE AMONG IN-HOSPITAL PATIENTS K Jabusch, B Lewthwaite, L Mandzuk, K Schnell-Hoehn, B Wheeler St. Boniface Hospital, Winnipeg, MB
Pain, both acute and chronic in nature is a widespread patient issue in all health care setting, including the cardiac population. Despite many improvement initiatives, inconsistent and inadequate pain management across all patient populations continues to be reported. Research links uncontrolled pain with potentially longer hospital stays, frequent post-discharge emergency room visits, early hospital readmissions, and lower patient and family satisfaction. Reflecting on the challenge of pain in providing cardiac care, this study investigates the prevalence of pain in a sample of patients on a single day in a Canadian tertiary care, urban hospital. This sample consists of in-hospital patients from various clinical programs including those on cardiology and cardiac surgery wards. The study goals are to provide a baseline measure of pain prevalence, and a benchmark for future quality improvement work. The Short Form-Brief Pain Inventory was the primary data collection instrument used to capture perceptions about pain severity and the degree to which pain interferes with feelings and daily functions. Using descriptive and inferential statistics, this presentation will review the study findings on pain frequency and the impact of pain on daily functioning. Gaining a better understanding of how admitted cardiac patients compare to others in different clinical programs will help guide the direction of cardiac nursing practice. As part of the review of implications for nursing practice for this study, this presentation will outline the role of nurses as the cornerstone of pain management during the assessment, delivery of pain relief strategies, and continuous evaluation of effectiveness of pain treatment.
NP011 CONTENT VALIDITY OF THE TORONTO PAIN MANAGEMENT INVENTORY-ACUTE CORONARY SYNDROME (ACS) VERSION S O’Keefe-McCarthy,1 M McGillion,1 S Nelson,1 S Clarke,2 J McFetridge-Durdle,3 J Watt-Watson1 1
University of Toronto, Toronto, ON, 2 University of Toronto, University Health Network, Toronto, ON, 3 Memorial University, St. John’s, NL
Pain arising from acute coronary syndromes (ACS) is severe and anxiety-provoking, which can potentiate myocardial damage. In rural settings, rapid access to cardiac catheterization (CATH) is problematic; ACS patients wait as long as 32 hours. In lieu of rapid CATH access, pain management should be optimal to prevent risk of deterioration and preserve vulnerable myocardial muscle. Evidence suggests that once ACS patients are stabilized, health care professionals (HCPs) do not adequately assess their cardiac pain. Clinicians lack of knowledge and problematic beliefs about pain may contribute to this problem. To date, no standardized tools are available to examine HCPs specific knowledge and beliefs about ACS pain that could inform future educational initiatives. The Toronto Pain Management Inventory was recently adapted to examine nurses knowledge about ACS pain assessment and management. OBJECTIVES/RESEARCH QUESTIONS: To examine content validity of the Toronto Pain Management Inventory-ACS version (TPMI-ACS), a measure designed to assess HCPs knowledge and beliefs of ACS pain assessment and management. METHODS: A survey design was implemented to determine the content validity index (CVI) of the TPMI-ACS version. Eight clinical and scientific experts rated the relevance of each item using a 4-point rating scale. A content validity index was computed for each item (CVI-I) as well as the overall scale using the Scale CVI Item Average approach (S-CVI/AVE); items with CVI-I ⬎ 0.7 were retained, items with CVI-I between 0.5-0.7 were revised/ clarified, and those with CVI-I ⬍ 0.5 were discarded. RESULTS: All 8 experts returned completed surveys yielding a 100% response rate. The CVI-I range across all items was 0.51.0. For 22 items, rated 3 or 4 only, the range was 0.75-1.0. Data indicated that the content of 22 of 25 items were deemed most relevant. One item was discarded based on consistent low relevancy ratings (i.e., 1 or 2). S-CVI/AVE was calculated for the 25-item TPMI-ACS draft as well as the revised 24-item scale, scores were 0.895 and 0.901 respectively, reflecting high inter-rater agreement across items. CONCLUSIONS: Preliminary content validity was established on the TPMI-ACS version. All items retained in the TPMI-ACS version met requirements for content validity. Further evaluation of the psychometric properties of the TPMI-ACS is needed to establish criterion and construct validity, as well as reliability indicators. BACKGROUND:
NP012 FASTRACK CARDIAC SURGERY C Kee, M Kroh, B Kiaii London Health Sciences Centre, London, ON