Analysis of Barriers to Implementation of the Defense Health Agency Procedural Instruction (DHA-PI) on Pain Management and Opioid Safety in the Military Health System
Abstract
Background: DHA-PI 6025.04 provides the MHS, an evidenced-based framework for pain management guided by clinical practice guidelines. Additionally, it seeks to establish the MHS Stepped Care Model for Pain Management (SCM-PM) for standardization of care across the enterprise, education to clinicians, clinical decision support tools, and pain research. The DHAPI implementation and execution have been identified as an area of improvement at Keesler Medical Center (KMC) by stakeholders. Clinical Question: What are the barriers to implementation of DHA-PI 6025.04 at KMC using the Consolidated Framework for Implementation Research (CFIR), as the basis of analysis? Project Design: Semi-structured interviews of stakeholders as detailed in DHA-PI 6025.04 at KMC. Each interview was conducted using open-ended standardized questions selected from the CFIR construct domains. Using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool, interviewee data were coded, aggregated, and analyzed. Data was used to identify the top ERIC strategies that provide the most benefit in addressing the implementation of the DHA-PI. Analysis of Results: Assessment of data indicates considerable heterogeneity in opinions regarding barriers to implementation. Of the CFIR constructs, approximately 10% were identified as the most pressing barriers. Nine Tier 1 and 30 Tier 2 ERIC strategies were identified as the most likely approaches to address the barriers to implementation. Organizational Impact: Adopting targeted strategies to the most significant barriers identified in this study will assist in implementing DHA-PI 6025.04 at KMC. Implementing this procedural instruction will enable the organization to provide a standardized, evidence-based platform for pain management services that effectively treats acute and chronic pain for beneficiaries.
Document Details
- Document Type
- Technical Report
- Publication Date
- Mar 30, 2020
- Accession Number
- AD1182692
Entities
People
- Edwin Fernandez
- Geoffrey Obia
- Leigh Kimmell
Organizations
- Uniformed Services University of the Health Sciences