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Improving Electronic Documentation of Pain Management in Nonverbal or Cognitively Impaired Outpatient Hospice Patients

Covington-East, Catherine RN, BSN, MA, CHPN; Best, Janie RN, DNP, ACNS-BC, CNL; Hines, Annette RN, PhD, CNE

Journal of Hospice & Palliative Nursing: May 2014 - Volume 16 - Issue 3 - p 182–188
doi: 10.1097/NJH.0000000000000042
Feature Articles

Hospice nurses are faced with the difficult circumstance of accurately assessing and treating pain in patients who are not able to communicate their pain experiences. Based on nurses’ identification of the need for a tool to help them with this vital assessment, a study was developed and completed. The purpose of this study was to revise the existing electronic pain assessment documentation in the electronic charting system to reflect a comprehensive pain assessment that included the Checklist of Nonverbal Pain Indicators. Specifically, the goals of the study were to incorporate (1) the Checklist of Nonverbal Pain Indicators into the electronic documentation tool, (2) the caregiver’s description of pain into the pain assessment, (3) documentation of pathologies potentially causing pain, (4) the patient’s response to treatment, and (5) documentation of patient/family goals for pain management. An additional goal was to improve the hospice nurse’s perception of documentation as a support in relieving patient suffering. The process of implementation of the new tool is described in detail with an accompanying timeline. The nurses’ perceptions of their ability to manage patients’ pain were higher (P < .001) when using the new tool. Implications for clinical practice based on the study results are presented.

Catherine Covington-East, RN, BSN, MA, CHPN, is staff nurse, Novant Hospice and Palliative Care, Charlotte, North Carolina.

Janie Best, RN, DNP, ACNS-BC, CNL, is assistant professor, Queens University of Charlotte, North Carolina.

Annette Hines, RN, PhD, CNE, is assistant professor, Queens University of Charlotte, North Carolina.

Address correspondence to Janie Best, RN, DNP, ACNS-BC, CNL, Queens University of Charlotte, 1900 Selwyn Ave, Charlotte, NC 28274 (

The authors have no conflicts of interest to report.

© 2014 by The Hospice and Palliative Nurses Association.