The hidden error of mismanaged pain: a systems approach.

Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.