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September 17, 2001

Software improves quality of patient care

Donna Price is communications coordinator for the Information Technology Division


Breakthrough technology, developed at Grady Hospital, is offering to improve pain management while saving nurses’ time. Last January, new standards for pain assessment were set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In addition to the four vital signs—pulse, temperature, respiration and blood pressure—hospitals must quantify pain (now being called the fifth vital sign) and document its management.

On the front line of pain assessment and treatment, hematologist James Eckman, director of the Grady Comprehensive Sickle Cell Center, and program coordinator Alan Platt witness the worst kind of acute pain in their work with sickle-cell anemia patients. Their efforts to improve pain care led to their development of an assessment technique, the Multidimensional Pain Score (MPS), for handheld computers that will also facilitate compliance with the new JCAHO Pain Standards.

“We started with this idea six years ago,” Platt said. “We’d been looking for a better way to quantify pain, so we could track how we’re doing. We wanted to raise the bar several notches.”

Their assessment tracks four dimensions of pain: intensity, mood, relief and side effects using a scale from 0–10. “There are more dimensions to pain, but we picked those four because we can do something about them,” Platt said. There is also a scale for those who cannot verbalize, he added, from the youngest baby to the cognitively impaired or intubated patient.

It took two years to write the research protocols, receive certification and begin the Phase 1 trial, an assessment of 50 sickle-cell patients. The MPS was compared with the “gold standard” for pain measurement, the McGill Pain Questionnaire, and the statistical results correlated.

The McGill questionnaire is a paper assessment tool that takes 20 minutes to complete. Evaluation is complex, requiring specialized training. It’s a useful tool for research but impractical for quick pain assessment. Nurses, the main assessors of pain at the bedside, are, in most hospitals, understaffed, overworked and already have a huge charting burden that limits time with patients. Using the MPS takes just one minute.

Platt experimented with programming the MPS on early Palm technology. “The thought was, here we have this quick way to record pain, but if we don’t make it a part of the nursing work flow [and] make their job easier, it’s never going to get done,” Platt said. “So why not collect 90 percent of [the data] nurses collect at the bedside, and record it all on the Palm?”

A Hewlett Packard touch-screen personal digital assistant (PDA) was the prototype Platt and Eckman first took to Emory around 1996, but a year later HP stopped the PDA’s production. In 1998, the researchers turned to Triad Technologies of Lawrenceville, where software was developed using the Palm OS System.

Triad’s resulting commercial product, docuCare, allows nurses to digitally document at the bedside not only the MPS but also vital signs, intake-output, therapy (including medications), weight and patient satisfaction with pain management. The PDA automatically time-and-date stamps the entries. When the handheld units are docked at desktop computers, the data interfaces with electronic patient record systems. The results can be printed, viewed graphically in spreadsheets, or used to generate summary reports.

West Georgia Health System in LaGrange was the test site for the pilot. “They saw the utility of it and tested it full bore on an orthopedic nursing floor for several weeks,” Platt said. The nurses—even the technophobes and those skeptics who had seen “revolutionary” systems come and go—were enthusiastic. It saved them time (a minimum of one hour per nurse per 12-hour shift) and was easy to learn because of the point-and-click interface and pull-down menus.

In the future, using handheld and wireless technology in hospitals will not only improve the quality of patient care for patient, but will also increase efficiency and accuracy in healthcare administration. For sickle-cell suffers, Platt envisions the use of the Internet for the collection of pain data by telephone from patients at home. Doctors will be able to monitor patient status, prescribe and adjust therapies over the Internet—another step forward in the battle to improve the quality of life for these patients worldwide.


Back to Emory Report September 17, 2001