The Barriers to High-Quality Inpatient Pain Management

Abstract

The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers.

Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting

“…1,2 Effective hospital-based pain management is compromised by a number of barriers, including patient perceived helplessness, lack of education and non-pharmacological interventions, and significant time delay in analgesic administration. 3 Poorly managed acute pain can lead to increased hospitalization costs, 3 reduced patient satisfaction, 4 and risk of persistent pain. 5 For alleviation of pain, more than half of patients in the U.S. are treated with opioids during hospitalization, 6 and 2-14% of these patients experience at least one opioid-related adverse event.…”

Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study

“…Barriers to optimal pain care include patient factors (eg, reluctance to report pain, fear of addiction), physician factors (eg, fear of overdose, addiction, distrust of subjective data, lawsuits), health system issues (eg, low priority, opiate policies), and inadequate pain assessment. 16,18–20 Clinical guidelines have not improved pain care. 16,19,20 This is primarily because translation of guidelines into practice has been affected by poor implementation leading to unintended consequences including oversedation.…”

The Current State of Perioperative Pain Management: Challenges and Potential Opportunities for Nurses

“…In some institutions, pain assessments may be frequent and accurate but the timing of pain medications and other interventions is delayed 50 . Reasons for the delay may be the need to complete mandatory safety procedures that reduce medication errors 50 or the institution's failure to address acute pain episodes with the same urgency as other medical emergencies 50 .…”

“…In some institutions, pain assessments may be frequent and accurate but the timing of pain medications and other interventions is delayed 50 . Reasons for the delay may be the need to complete mandatory safety procedures that reduce medication errors 50 or the institution's failure to address acute pain episodes with the same urgency as other medical emergencies 50 . Another system‐related barrier to adequate pain management is the limitation of clinical staff resourcing for modalities that require considerable vigilance for monitoring and avoidance of AEs (eg, epidural hematoma, catheter migration associated with patient‐controlled epidural analgesia) 51 .…”