Providence Rest Nursing Center: Pain Measure Improvement

The Providence Rest Pain Management Team. Seated, left to right: Lynn Berger, ADN; Dr. Jocelyn Ronquillo, Medical Director; Flora May Ymalay, Director of Nursing; Josette Varela, CTRS; Karen Bacolod, PT. Standing, left to right: Gloria Bito, MDS Coordinator; Thomas Rowan, Director, Spiritual Care; Rosemarie Hofstein, Director, Social Services; Alice Cardo, Staff Development/CQI Coordinator; Peggy Spatta, RN, CCC; Lucy Gibson Paul, RN, Unit Manager; Narda Green, Dietician. Not available for photograph: Michelle Ongkiko, RN, Unit Manager; Denise Ythier, PA; and Dr. Annama John, Primary Care Physician.

Providence Rest Nursing Center, a 200-bed facility in the Bronx, joined the Nursing Home Quality Initiative (NHQI) as a member of the New York State Nursing Home Identified Participant Group. The team chose to work on the Chronic Pain Management and Post Acute Pain Management Quality Measures. For Chronic Pain Management, the facility started below the national averages and improved from 8% to 1%. Post Acute Pain Management started above the national average and improved 26% to 5% (June 2002 to June 2004).

The facility's interdisciplinary team reviewed existing systems and processes related to the Pain Management Quality Measures for the Chronic and Post Acute populations. Initially, the team met every week. Now, they meet on a monthly basis, with plans to decrease frequency to once every quarter, promoting more staff time with residents on the units.

Areas for improvement were identified by reviewing assessment tools, flow sheets, and care plans. Focusing on use of assessment tools, the team developed a one-page comprehensive form to be used for both cognitively impaired and cognitively intact residents. The team identified pharmacological and non-pharmacological interventions. The facility began using the IPRO data tracking tool for concurrent review of their residents' records at their weekly care plan meeting.

Providence Rest was one of two New York State skilled nursing facilities featured by the Centers for Medicare & Medicaid Services (CMS) in materials developed for U.S. Health and Human Services Secretary Tommy Thompson. Thompson used the materials at a Washington, DC press event highlighting the strong working relationships developed by nursing homes and QIOs across the United States.