Nominal group technique: A brainstorming tool for identifying areas to improve pain management in hospitalized patients

BACKGROUND: Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. OBJECTIVE: To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. DESIGN: Qualitative and quantitative group consensus using a brainstorming technique for quality improvement—the nominal group technique (NGT). SETTING: One medical, 1 medical‐surgical, and 1 surgical hospital unit at a large academic medical center. PARTICIPANTS: Nurses, resident physicians, patient care technicians, and unit clerks. MEASUREMENTS: Responses and ranking to the NGT question: “What causes uncontrolled pain in your unit?” RESULTS: Twenty‐seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. CONCLUSIONS: Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context‐specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine