Development of pain management stewardship program and evaluation of its impact on pain management practice in a tertiary care hospital

Development of pain management stewardship program and evaluation of its impact on pain management practice in a tertiary care hospital.

**Background:**The prevalence of Chronic pain in India is 19.3% and in the upcoming two decades the prevalence may significantly rise, adversely affecting the global health level, man-hours, and total national economy. Pain management is a vital part of healthcare services. Most physicians did not assess the types of pain and did not use any tools to evaluate the intensity of pain. Appropriate documentation of pain is one of the important steps in pain management. The proper assessment of pain is very important to begin and assess the effectiveness of pain treatments.  A survey across 10 Asian countries to assess the attitude towards cancer pain management resulted that, 49.5% of patients reported that no scale was used for assessing the pain and 49.7% of physician reported poor pain assessment as an important barrier to pain therapy.  Poor pain assessment and documentation resulted in undertreated pain; it also happens in Indian hospitals. We aimed to identify, harmonize and validate a standard pain assessment tool for the Indian health care setting.

Objectives:

·  **To evaluate the practice of pain management:**Assess the current practice of pain assessment and documentation, Assess the clinical decision-making process of analgesics use, Evaluate the usage Pattern of analgesic, Assess the barriers faced by health care providers in the pain management practice.

· **Harmonization of brief pain inventory (BPI) for the Indian healthcare setting:**Qualitative study (physician, In patient, In nurses)

·    Expert review

Psychometric testing of BPI

Methodology:

Phase 1 (Baseline survey- 6 months)

· Predesigned proforma will be developed and validated with the help of pain experts. Details regarding the current practices of pain assessment and documentation, clinical decision-making process of analgesics use, usage pattern of analgesics will be evaluated by screening the case records of the patients, through interviews and the data will be recorded in the pre-designed proforma.

Phase 2(Assessing barriers- 6 months -Parallel to phase 1)

Develop and validate questionnaire for the evaluation of barriers faced by the health care providers in the pain management practice with the help of pain expert and healthcare providers. The questionnaire will be rolled-out to the healthcare providers and their response will be recorded.

·   Phase 3 – Harmonization of Brief pain inventory (1 year)

Participants will purposively recruit and interviewed in-depth. The in-depth interviews will be transcribed and coded using NVivo software. The interview transcripts will be analysed using the reflexive thematic analysis. Participant who are experiencing pain and those who are involved in the pain management will explore the concepts defined by each item in the BPI scale from their perspective. Considering the current COVID-19 pandemic, face to face interviews or telephonic conversations will be considered depending upon the convenience of the participants.

Phase 4 (3 months)- Expert review

·  Each result obtained from the Phase 1,2,3 will be brought together and evaluated, reviewed, and revised. Nominal group discussion technique will used to evaluate the concept, content, experiential and semantic.

Phase 5(3 months)- psychometric testing

The psychometric properties of the questionnaire including quantitative and qualitative face validity, quantitative and qualitative content validity, construct validity and reliability of the tool will be assessed.

Outcome measures: harmonization and validation of uniform pain management system for an Indian hospital setting.