Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Philip Cole
Abstract
Problem: Chronic pain is a significant health problem, and veterans experience higher pain severity than nonveterans. On an acute care unit of a Veterans Affairs Medical Center, pro re nata (PRN) pain medication reassessment was inconsistent and below the facility’s 92% benchmark. PRN pain reassessment compliance averaged 81.6% from November 2025 to January 2026. The Joint Commission requires timely pain assessments. The facility’s Medical Center Policy (MCP) mandates reassessing PRN pain medication within 120 minutes of administering it. The acute care unit leadership identified limited visual or electronic prompts as contributing factors to the practice gap.
Aim of the Project: The aim of the project was to improve PRN pain medication reassessment within 120 minutes of administration.
Review of the Evidence: The evidence established a need for timely reassessment supported by reliable clinical processes. Technology-enabled visibility can increase awareness and reduce variation, while standardized processes and education reinforce reassessment behaviors. Workflow interruptions, workload, and competing priorities can interfere with documentation, making visual communication important for practice.
Project Design: A quality improvement (QI) framework was used to guide the project. The Plan-Do-Study-Act (PDSA) cycle was used to support gap identification, change testing, workflow evaluation, and refinement. The OhioHealth Change Management Model (OHCM) was used to support readiness, leadership engagement, and sustainability of the QI project.
Intervention: A color-coded PRN effectiveness dashboard was implemented and embedded in the barcode medication administration (BCMA) software. The dashboard displays medication administration time, administering nurse, and elapsed time. Green, orange, and red indicators identify reassessments within, approaching, or exceeding 120 minutes.
Significant Findings/Outcomes: After implementation of the dashboard, PRN pain reassessment compliance averaged 89% from March 2026 to May 2026. Compared with the 81.6% three-month baseline average, compliance increased by 7.4% despite 199 more PRN pain medications being administered. Although the 92% benchmark was not reached, an 89% three-month average represents improvement with higher medication volume and fewer missed reassessments.
Implications for Nursing: The practice change supported timely pain management, reduced risks associated with unmanaged pain, and contributed to safe, effective, patient-centered, timely, and equitable care aligned with the Triple Aim framework. Continued dissemination through posters, seminars, and conferences can support broader adoption, while monitoring, dashboard use, and leadership support can sustain improvement.
Recommended Citation
Adu-Gyamfi, Safo, "Improving PRN Pain Medication Reassessment for Veterans in Acute Care" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 86.
https://fuse.franklin.edu/dnp-project/86
Rights
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