NR 642 Week 6 Evidence Review Example

Evidence Review: What Hospitals Built to Improve Pain Reassessment Documentation, Grouped by the Thing That Went Into the Record

Student Name

College of Nursing, Chamberlain University

NR 642: Informatics Nurse Specialist Concluding Graduate Experience I

Instructor Name

Month Day, Year

Evidence Review: What Hospitals Built to Improve Pain Reassessment Documentation, Grouped by the Thing That Went Into the Record

How the Review Is Organized

By what was put in: flowsheet and policy changes, reports and feedback, reminders inside the record, and alerts. For each, the facts an informatics reader needs: the setting, whether one site or many, how many users, whether the change could be bypassed and who supported it once live.

Group 1: Flowsheet and Policy Changes

What went in. At a large academic medical center, a multi-year improvement cycle combined a new pain reassessment policy, repeated education with bedside coaching, changes to the daily bedside documentation flowsheets and audit with feedback (Gordon et al., 2008).

Configuration facts. One organization; flowsheet changes were one of several simultaneous changes; managers and leaders coached at the bedside; audits were daily and monthly.

Result. A cumulative 94.9% of pain reassessments appropriately documented over about two years. The authors were clear that the flowsheet changes alone were not enough and that leadership involvement, persistent audit and accountability were necessary.

Fit here. The project cannot reproduce the coaching or the leadership effort, so it should expect less from a build change alone.

Group 2: Reports and Feedback

What went in. At two hospitals on one campus, a computer-generated report produced an individual report card for each nurse on pain reassessment documentation (Cline, 2016). In a community hospital emergency department, daily audits of individual nurses and a weekly newsletter of unit rates were introduced after focus groups (Wissman et al., 2020).

Configuration facts. The report card used existing documentation and could not be bypassed, because it measured rather than prompted. The emergency department project ran over eight months with 581 encounters reviewed.

Result. The emergency department rate rose from 36.2% to 62.3% over the three months that followed the intervention period. The report card project describes the method more than the effect size.

Fit here. A report alone would tell nurses that their reassessments are filed in the wrong place, but would not make the right place easier to find. It is a useful companion, and a fallback if build is refused.

Group 3: Reminders Inside the Record

What went in. In a neonatal intensive care unit, a team using the Model for Improvement tested electronic record changes, a trigger report showing missed reassessments, text messages and emails to bedside nurses, in-person education and an annual competency module (Israel et al., 2023).

Configuration facts. One unit; a reassessment within one hour after a high pain score; the record reminder was one of several interventions; sedation scores were tracked as a balancing measure.

Result. Reassessments rose from 50% to the 75% goal, which was sustained for two years. The authors credited the trigger report with making noncompliance visible and the record reminders with helping to sustain the change.

Fit here. This is the closest match to a worklist task. It suggests a reminder can help sustain a gain, and that a trigger report made the gain possible in the first place.

Group 4: Alerts That Can Be Clicked Past

What went in. In a study of a clinical decision support system in primary care, the authors examined how workload, complexity and repeated alerts affected whether alerts were accepted (Ancker et al., 2017).

Result. Alert acceptance fell as clinicians saw more alerts and more repeats; repeated alerts were associated with fatigue.

Fit here. A pop-up at the 30- or 60-minute mark would add to the alerts nurses already see. A worklist task that waits quietly in a list, rather than interrupting, is the design this evidence favors.

Comparing Configuration Across Groups

Every source is a single setting, and every change could be worked around. That is normal for documentation changes, where a hard stop would block care, and is why the worklist task is designed to be dismissible with a reason rather than forced.

The Unglamorous Sources

The record vendor's worklist build guide, available to the hospital's analysts, describes creating tasks from medication administration events with a due time offset; the clinical documentation analyst confirmed the hospital's version supports it. A presentation at the vendor's regional nursing user group in 2025, shared by the analyst, described another hospital's PRN reassessment task, which reported high task completion but also complaints about tasks firing for doses that did not need reassessment. The hospital's own release notes for the November 2026 upgrade list no changes to worklist tasks, so the build would not be disturbed by it.

Where Sources Disagree, and Why

The flowsheet group reached 94.9%; the emergency department reached 62.3%; the neonatal unit reached 75%. These are not competing findings about what works. They differ in configuration: one changed many things at once with heavy leadership involvement; one used audit and newsletters without changing the record; one combined record reminders with reports. They also differ in when they measured. Every project measured during the months when everyone was watching, and that attention effect is part of each result. The review cannot separate it.

What None of the Sources Tested

None of the studies tested a worklist task alone, without education, reports or leadership coaching alongside it. None was set on adult medical-surgical units with this record's build. And none separated where reassessments were filed from whether they were done, which is the distinction at the center of this project. The evidence supports the design but cannot predict its size of effect here.

Handed Forward

To the measurement plan: use the existing report logic so results stay comparable; add the share of reassessments filed in the routine row as a companion measure; and plan for the attention effect by measuring for long enough after any change that a novelty bump can fade. To the design: a quiet task, not an alert; a firing list agreed with pharmacy so tasks fire only for doses that need reassessment; and a trigger report as a companion or fallback.

References

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Medical Informatics and Decision Making, 17, Article 36. https://doi.org/10.1186/s12911-017-0430-8

Cline, M. A. (2016). Increasing RN accountability in professional practice: Development of a pain reassessment documentation scorecard. The Journal of Nursing Administration, 46(3), 128-131. https://doi.org/10.1097/NNA.0000000000000311

Gordon, D. B., Rees, S. M., McCausland, M. R., Pellino, T. A., Sanford-Ring, S., Smith-Helmenstine, J., & Danis, D. M. (2008). Improving reassessment and documentation of pain management. The Joint Commission Journal on Quality and Patient Safety, 34(9), 509-517. https://doi.org/10.1016/S1553-7250(08)34065-3

Israel, S., Perazzo, S., Lee, M., Samson, R., Safari-Ferra, P., Badh, R., Abera, S., & Soghier, L. (2023). Improving documentation of pain reassessment after pain management interventions in the NICU. Pediatric Quality & Safety, 8(5), e688. https://doi.org/10.1097/pq9.0000000000000688

Wissman, K. M., Cassidy, E., D'Amico, F., Hoy, C., Vissari, T., & Baumgartner, M. (2020). Improving pain reassessment and documentation rates: A quality improvement project in a teaching hospital's emergency department. Journal of Emergency Nursing, 46(4), 505-510. https://doi.org/10.1016/j.jen.2019.12.008