What variable should be improved for quality improvement in a hospital where two women of the same age and ethnicity are receiving morphine (opioid analgesic) at different intervals, one every 6 hours and the other every 3 hours?

From the Guidelines

The variable that should be improved for quality improvement in this hospital is the standardization of morphine dosing intervals based on patient-centered care and evidence-based pain management protocols. When two women with the same demographic characteristics (age and ethnicity) in the same hospital are receiving different dosing schedules of the same medication (morphine), this indicates a potential lack of standardized, patient-centered care. According to the most recent and highest quality study 1, normal release morphine does not need to be given more often than every 4 hours, and this study provides the most up-to-date guidance on morphine administration. The variation in dosing frequency (every 6 hours versus every 3 hours) without a clear clinical justification suggests that pain management protocols may not be consistently applied based on patient-specific factors like pain severity, metabolism differences, or patient preferences. Some key points to consider for improving pain management include:

• Standardizing pain assessment tools to ensure consistent evaluation of pain severity
• Implementing evidence-based pain management protocols, such as those recommended by the European Association for Palliative Care 1
• Ensuring consistent documentation of pain scores to track patient response to treatment
• Incorporating patient feedback into pain management decisions to tailor treatment to individual needs and preferences
• Considering the use of rescue doses for breakthrough pain, as suggested by 1, to provide additional relief when needed By addressing these areas, the hospital can improve patient-centered care and reduce unnecessary variations in treatment, ultimately leading to better outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Initiate treatment with morphine sulfate tablets in a dosing range of 15 mg to 30 mg every 4 hours as needed for pain The variable that should be improved for quality improvement in a hospital where two women of the same age and ethnicity are receiving morphine at different intervals is standardization of dosing intervals.

• The recommended dosing interval for morphine sulfate tablets is every 4 hours as needed for pain 2.
• The current practice of administering morphine at different intervals (every 6 hours and every 3 hours) may indicate a lack of standardization in pain management.
• To improve quality, the hospital should consider implementing a standardized protocol for morphine administration, taking into account individual patient needs and response to treatment.
• This may involve titrating the dose to provide adequate analgesia and minimize adverse reactions, as well as continually reevaluating patients to assess the maintenance of pain control and the relative incidence of adverse reactions 2.

From the Research

Quality Improvement in Hospitals

To improve quality in a hospital where two women of the same age and ethnicity are receiving morphine at different intervals, several variables can be considered for improvement.

• Patient-Centred Care: Improving patient-centred care is crucial for quality improvement in hospitals 3. This involves considering the individual needs and preferences of patients, which may include adjusting the frequency of morphine administration.
• Quality Management Strategies: However, research suggests that hospital-wide quality management strategies may not have a substantial association with patient-reported experience measures 4. This implies that improving quality management strategies alone may not directly impact the care received by patients.
• Staff Engagement and Barriers: Staff engagement and barriers to quality improvement initiatives can significantly impact patient care and safety 5. Identifying and addressing these barriers, such as lack of time and prioritization of quality improvement initiatives, can help improve patient care.
• Process Improvement Strategies: Implementing process improvement strategies, such as designing and implementing quality improvement research, can help improve surgical patient care 6.
• Medication Management: Considering alternative medications or combinations of medications, such as melatonin and morphine, may also be beneficial for improving patient care and reducing side effects 7.

Key Considerations

When improving quality in a hospital, it is essential to consider the complex relationships between different variables and their impact on patient care. This includes:

• Individual Patient Needs: Considering the individual needs and preferences of patients, such as adjusting the frequency of morphine administration.
• Staff Engagement: Engaging staff in quality improvement initiatives and addressing barriers to implementation.
• Quality Management Strategies: Implementing effective quality management strategies that prioritize patient-centred care.
• Medication Management: Considering alternative medications or combinations of medications to improve patient care and reduce side effects.