An evaluation of the development and implementation of a pain management guideline for the Knysna Provincial Hospital
Introduction Pain is the symptom that most frequently brings patients to the hospital and impacts on the quality of patients and their families’ lives, yet researchers have shown that barriers to effective pain management for patients who suffer chronic pain remain. The barriers include professional, patient and system issues. Many of these issues could be seen at the Knysna Provincial Hospital. The literature reveals that the implementation of a guideline increases the success of the pain management process. This research looks at the implementation of a site specific guideline at the Knysna Provincial Hospital. Methodology This study incorporates both quantitative and qualitative analysis. The study has two phases; the first includes a quantitative analysis of file audits and the thematic analysis of three focus groups held to determine barriers and facilitators of the pain management process. Using the information garnered in phase-1 a guideline is developed and implemented. Phase-2 involves the quantitative analysis of files after the implementation of the guideline. Data management and analysis Data from the file audits in both phase-1 and phase-2 was analyzed using quantitative analysis techniques using the software; IBM SPSS 24.0. Data from the focus group discussion was thematically analyzed. Using data from the phase-1 audit and the themes from the focus group discussions a chronic pain management guideline was developed. The guideline was implemented and the phase-2 file audit was performed to establish the effect of the guideline on the pain management process at the Knysna Provincial Hospital. Ethical Considerations All participants of the focus group discussions were given sufficient information about the study to make an informed consent. Ethical approval was obtained from the UCT Faculty of Health Sciences Human Research Ethics Committee. Permission to conduct the research was obtained from the Western Cape Department of Health, Knysna Provincial Hospital, and the Knysna Sedgefield Hospice Board of Directors. Findings This study aimed to identify the barriers and facilitators to good pain management and use the findings to create a guideline. The focus group discussions showed that the current practice was inconsistent; the focus groups identified several barriers and facilitators to improved pain management. The initial file audit showed 84% of patient’s pain was assessed and only 59% were reassessed. Using the data from the file audit and FGD, a guideline was created to meet the needs of the Knysna Provincial Hospital. The file audit post the implementation of the guideline showed improved pain management processes with initial assessment at 100% and reassessment at 71%. The implementation of the new guideline was flawed and only 35% of files audited showed evidence that the new process was used. Conclusion The guideline developed based on the file audits and identification of barriers and facilitators during focus group discussions improved the pain management process at the Knysna Provincial Hospital.
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Department of Public Health and Family Medicine