Development and implementation of a quality improvement initiative: Systematic follow-up of patients who have spinal cord stimulator implants

Recent medical advances and the rising prevalence of chronic pain in the US population contribute to the use of spinal cord stimulator (SCS) implant as a treatment modality for chronic pain management. As the numbers of patients receiving SCS implants steadily increases, the challenge of managing this device grows and the need for SCS implants follow-up programs rises. Follow-up programs need to focus on implant longevity and efficacy to improve the quality of care outcomes.;This Doctor of Nursing Practice (DNP) quality improvement initiative was developed to provide systematic follow-up for patient with SCS implant. The project includes the creation of a database for all of the SCS implants currently managed by this medical center; development and administration of the questionnaire to improve the effectiveness of this modality; development of a multidisciplinary team, including the representatives of the device manufacturers, to improve device management; and maintenance of the treatment space to assure timely access by appointment.;Data were collected via a questionnaire, administered to 80 patients as part of the follow-up program. Analysis of the data yielded these patient outcomes: 33 (41.25% of respondents) had satisfactory pain coverage requiring no further intervention; 27 (33.75%) needed SCS device reprogramming; 7 (8.7%) required surgical intervention for SCS implant management; 6 (7.5%) needed interventions but were not ready to receive the intervention; and 7 (8.75%) patients requested additional procedure for pain management augmentation.;Post hoc comparisons using the Bonferroni adjustment for Type I error rate inflation showed that patients who reported a remodulation time of less than 6 months (M = 4.97, SD = 2.35) reported significantly less pain than patients who reported a remodulation time between 6 and 12 months (M = 5.65, SD = 2.16) and more than 12 months (M = 5.86, SD = 2.66). The pairwise comparison between patients who reported remodulation time between 6 and 12 months and more than 12 months was not significant, p > .05. Thus, the greater the time since remodulation of SCS implant, the more pain patients reported.