1814 - Addressing Inadequacies in Pain Care: A Quality Improvement Initiative in a Safety-Net Rehabilitation Center

Objectives: Effective pain control is essential to optimize functional recovery and quality of life for patients in rehabilitation while minimizing side effects. Following the implementation of a new electronic medical record (EMR), multiple deficiencies in pain management were uncovered, including improper as-needed medication (PRN) ordering by physicians, inaccurate documentation, and ineffective administration. A quality improvement project was conducted at an academic safety-net inpatient rehabilitation center to address these gaps, strengthen patient care, and enhance patient outcomes.

Design:

Plan: Root cause analysis identified improper PRN orders, inconsistent documentation by physicians and nurses, and untimely administration as major contributors to inadequate pain control.

Do: The first PDSA cycle included physician order optimization, physician education on EMR documentation, automated reminders for timely administration, and audit-feedback cycles.

Study: Each week, 10 random pain medication administrations were reviewed to assess concordance between physician orders and nursing administration. Weekly accuracy rates were averaged into monthly success rates and tracked from February 2024 to May 2025.

Act: Prior to the second PDSA cycle, additional interventions were implemented: direct nursing management oversight, structured nurse teaching, and adoption of visual analog pain scores for standardized assessment.

Results: At baseline (February–April 2024), administration accuracy was only 5–12%. After the first PDSA cycle, rates improved modestly to 20% but remained inconsistent. Following the second cycle, adherence rose steadily: 60% by November 2024, 70% by February 2025, and 76% by May 2025. Overall, pain medication administration improved from 10–20% at baseline to consistently above 70%, peaking at 90%.

Conclusions: Iterative PDSA cycles that combined EMR optimization, physician order correction, staff education, nursing management oversight, and structured pain assessment substantially enhanced medication administration. This initiative demonstrates that adoption of a new EMR, while challenging, can serve as a catalyst for identifying gaps and driving system-level improvements in pain management for underserved rehabilitation populations.