Evaluating the impact of Inpatient Pain Management Interactive Systems

Abstract

The management of patients’ pain is essential for improving the overall quality of patient care. Equally important, is the patient’s role in managing their pain and the health system’s role in creating the ideal environment that supports high quality patient-centered care. Accordingly, many hospitals have and are investing in patient engagement technology systems aimed in supporting patients in their pain management care process. Despite the decade-plus existence of pain interactive entertainment systems, which are designed to distract patients from pain during treatment, their role in the management of pain remains understudied. Some of these interactive systems, in addition to their entertainment features, also include other functions to deliver standardized patient education and support the integration of patient-reported pain assessments into the electronic health record (EHR). However, despite technological advances that support this integration, this functionality is rarely implemented and researchers have rarely studied the effects of adopting interactive pain management systems (IPMS) in the inpatient setting. The objectives of this body of research are to address this gap in knowledge by evaluating various aspects of IPMS. The study was conducted in four phases: 1) examining the current evidence around and the state of IPMS, 2) evaluating the effect of a novel IPMS at the University of Minnesota Masonic Children’s Hospital (UMMCH), 3) characterizing user experience and satisfaction with use of IPMS and 4) understanding the population that utilizes the inpatient IPMS for the management of pain. We conducted a systematic literature review across seven databases to understand the current state of IPMS in an inpatient setting and examine their clinical outcomes. Out of the reviewed full-text articles, 17 were eligible and included in the final qualitative synthesis. Overall, there were two main types of IPMS within the inpatient setting; stand- alone systems and integrated platform systems. Reports examined a variety of outcome measures, including changes in patient-reported pain levels, patient engagement, user satisfaction, changes in clinical workflow, and changes in documentation. In our second study, we conducted a mixed methods case study approach to describe the development of a IPMS at the UMMCH and to evaluate the impact of implementation on clinical workflow, patient use, and compliance with nursing documentation of their pain reassessments. We employed a retrospective analysis of 56,931 patient records covering pre- and post- implementation. Despite nursing pain reassessment documentation being relatively low, implementation of the system led to a statistically significant increase in the overall nurse documentation and resulted in patient access to nonpharmacologic strategies to eliminate pain. In our third study, benefits and challenges on the use of an inpatient IPMS were identified by parents and nurses. Overall, there was a cohesive agreement among users regarding the impact of the IPMS in engaging and empowering patients/families, increasing patient satisfaction, and creating a communication platform, with the most usefulness feature being “Support of Timely Pain Reassessments”. Thematic content analysis was conducted to analyze nurse responses and identify high level themes. Six themes emerged related to “Benefits” from using the system: Phone Reminders, EHR Automatic Documentation, Decision Support, Patient Empowerment, Sense of Connection and Non-Medication Resources. There were also 12 “Challenges”: Uncertainty of Patient Rating Scores, Training Needs, Distraction, Discourage Best Practice, Low Utilization, Low Utilization Due to Environmental Factors, System Design Limitations, Pain Scale Discrepancy, Low Utilization Due to Patient Factors, Patient/Family Dissatisfaction, Workflow and Duplicate Charting Requirement. The ability to identify user experience associated with the use of these systems, potentially assists in designing IPMS to maximize positive impact on clinical outcomes and care quality. Finally, by conducting a retrospective analysis of inpatient records, our fourth study demonstrated differences in the patients’ IPMS usage among different hospital units based on the care and medical service these units provide and an increased usage was associated with the time of medication administration. Overall, this research collectively demonstrated the benefits of IPMSs and showed the potential of these systems in improving the patient and provider experience and the quality of care. Evaluating the effects of these systems on clinical outcomes, patient satisfaction, hospital workflow, and barriers and facilitators associated with the use of these systems is an important component in developing meaningful health information technology (HIT) systems to engage patients and address pain.