Read the following scenario:

Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.

You have been the day shift representative to the QI team, and the scores on your unit are posted monthly. Here are the numerous strategies that have been tried on your unit and the timeframes.

Strategies and Interventions

1/14/2014 Training on the importance of patient satisfaction monitoring

4/1/2014 Lecture on pain and pain management

6/12/2014 Use of comprehensive pain assessment tool reviewed in an ISE

8/2/2014 Journal club on R5N reviewed an article on pain management

10/10/2014 EMR data on pain assessment reviewed in QI team

1/15/2015 Data on pain management satisfaction posted on unit

3/1/2015 EMR data on pain medication effectiveness reviewed in QI team

5/15/2015 QI team meets with staff to strategize; determined to use IHI rapid cycle

improvement model with iterative PDSA

6/30/2015 Annual pain lecture: emphasis on the elderly use of NSAIDS, pain

management, & polypharmacy

7/15/2015 EMR data on pain medication effectiveness documentation shows

improvement for one month

8/30/2015 ISE on the importance of patient teaching on pain management

9/1/2015 ISE on attitudes toward addiction in the elderly (poorly attended by staff)

9/30/2015 Data on comprehensive pain assess, doc of pain meds and patient

satisfaction, compiled in run charts for the unit

10/15/2015 ISE on attitudes offered with ANCC contact hours; 100% attendance on


12/28/2015 QI team summarizes strategies, progress at year end with unit nursing


1/22/2016 Data on comprehensive pain assessment, doc pain meds effective shows

improvement on these

3/1/2016 Nursing unit claims victory on improved patient satisfaction with pain


For this Discussion, examine the strategies and interventions tried in your unit and consider the following questions: a) Were the strategies effective in creating a sustainable change on your nursing unit, and b) To what extent can your nurse manager and CNO count on your unit exceeding the national benchmark in the next quarter, the next year? That is, does this run chart have some predictive ability? Does the run chart support the nursing unit’s decision to celebrate? To what extent can the leadership be confident that the trend will continue?

Based on the scenario, explain what was done successfully and where improvement was needed in the quality improvement process. Identify the quality improvement tools and explain how they contributed to the outcome.

Support your response with references from the Resources and professional nursing literature. Your posts need to be written at the capstone level.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use  from the readings and include  . Utilize  writing practice and skills, including the use of  and  . Avoid quotes;  to incorporate evidence into your own writing. A  is required. Use the most  (usually ≤ 5 years old).

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