September 17, 2001
Software improves quality of patient care
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 signspulse, temperature, respiration and blood pressurehospitals
must quantify pain (now being called the fifth vital sign) and document
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. Wed
been looking for a better way to quantify pain, so we could track how
were 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 010. 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. Its
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 dont make it a part of the nursing work flow [and] make their
job easier, its 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 PDAs production. In 1998, the researchers turned
to Triad Technologies of Lawrenceville, where software was developed using
the Palm OS System.
Triads 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 nurseseven
the technophobes and those skeptics who had seen revolutionary
systems come and gowere 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 Internetanother
step forward in the battle to improve the quality of life for these patients