Implementation of pain best practices as part of the spinal cord injury knowledge mobilization network

Abstract

Context/objective: The spinal cord injury (SCI) knowledge mobilization network (KMN) is a community of practice formed in 2011 as part of a national best practice implementation (BPI) effort to improve SCI care. This study objective was to determine whether completion and documentation of pain practices could be improved in a neurorehabilitation setting using the KMN implementation approach.

Design: Single site, pre–post intervention study.

Setting: Neurorehabilitation hospital.

Participants: Twenty sequential consenting inpatients with SCI, with retrospective comparative analysis of 50 sequential SCI admissions pre-KMN.

Interventions: A local Site Implementation Team (SIT) was formed to develop an implementation plan, including acceptable timeframes for completion and documentation of four specific pain best practices: (1) pain assessment on admission, (2) development of an Inter-Professional Pain Treatment Plan (IPTP), (3) pain monitoring throughout admission, and (4) a pain discharge plan.

Outcomes: Provider adherences to pain best practices were the primary outcomes. The secondary outcome was patient satisfaction.

Results: Provider adherence for most outcomes exceeded 70% completion within acceptable timeframes, with improvements found for all outcomes as compared to the retrospective cohort. Notably, pain education as part of the IPTP improved from 12% completion to 74%, documenting pain onset from 4.5% to 80% and pain discharge plan from 40% to 74%. Overall, participants were satisfied with their pain management.

Conclusions: Pain best practices were more consistently documented after the KMN implementation. Pain practices in all four areas have now been expanded to all inpatient diagnoses using the same forms and framework created in the implementation process.

Keywords:

• Spinal cord injury
• Rehabilitation
• Implementation
• Pain management

Acknowledgements

The authors would like to acknowledge the National SCI KMN team for their assistance with Saagar Walia, Jacquie Brown, Carol Scovil and Anna Kras Dupuis providing helpful mentoring for our local implementation efforts, along with members of our Site Implementation Team: Rebecca Mills, Erica de Passillé, Karen Dickinson, Susan Brophy, and Allison Banks.

Ethics approval

This study received approval from the Horizon Health Network Research Ethics Board.

Additional information

Funding

This study received joint funding from the Stan Cassidy Foundation and the New Brunswick Health Research Foundation, and also funded by the Rick Hansen Institute and Ontario Neurotrauma Foundation.