Date of Award

Fall 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Catherine Colleran

Second Advisor

Juraj Melek

Abstract

BACKGROUND: Effective pain management remains a critical challenge both globally and with the United States, where more than 51 million adults suffer from pain. Veterans are particularly vulnerable due to the lasting impact of service-related injuries. “Pro re nata” (PRN or “as needed”) pain medications are frequently used to manage pain, but timely reassessment and documentation following a PRN pain medication administered is often missed or delayed. Reassessing and documenting the results after the administration of the PRN pain medication is required by The Joint Commission and the Veterans Affairs Providence Healthcare System’s (VAPHS) standard operating procedure (SOP) states reassessment of a PRN medication should be documented within 120 minutes of administration. Incomplete documentation can lead to poor pain control, reduced quality of life, longer hospital stays, and negative patient outcomes. Data from one of the units revealed a 67% PRN effectiveness rate falling short of the 75% benchmark. This project aimed to improve the PRN effectiveness rate.

METHODS: Literature review was conducted which provided evidence-based information regarding strategies on improving PRN effectiveness rate. The Plan-Do-Study-Act (PDSA) framework in conjunction with the Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) change model worked well for this project. Data was collected for 3 months prior to implementation, and a total of 873 PRN pain medications were administered with a 67% rate.

INTERVENTION: A color-coded, real-time visual aid reminder, such as a dashboard was utilized for maintaining accurate, just-in-time data to help with reminders to reassess and document patient evaluation. The dashboard displays the patient’s name, room number, medication, nurse who gave the medication, time the medication was given, and the number of minutes since the medication was given.

RESULTS: A total of 636 PRN pain medications were administered during the data collection period, resulting in a PRN effectiveness rate of 73%. The two-proportion z-test was conducted and the analysis revealed that there was a statistically significant difference between the pre/post intervention documentation rates, z=-2.37, p=0.018.

CONCLUSION: Overall, the real-time, color-coded visual dashboard led to a 6-percentage point increase and the intervention showed a positive impact on Veterans.

Download

Included in

Nursing Commons

Share

COinS