Managing Pain and The Patients’ Perspective: A Collaborative Approach Beth Israel Deaconess Medical Center Introduction/Problem BIDMC’s HCAHPS patient satisfaction scores related to pain management illustrated opportunity for improvement. The hospital fell outside of the target zone for payer reimbursements for this metric since FY2014. Patient feedback indicates opportunity exists with Staff Attentiveness Patient Perception of Staff Attentiveness and Response 12 Reisman agreed to be one of three inpatient units to pilot pain management initiatives in FY2016, with a plan to spread successful initiatives to additional inpatient units accordingly. Aim/Goal The Interventions By improving pain management patient satisfaction results for 12 Reisman, in combination with the results of other piloting inpatient units, it will impact BIDMC’s overall pain management patient satisfaction scores and lead to a 2% increase by end of the fiscal year 2017. Design and Implementation of Staff Survey to assess educational needs related to pain management. Inclusion of 2 Pain-related Quality Measures as part of the Decision Management System (DMS) Based on learning opportunities identified through the staff surveys, patient satisfaction data and documentation audits, pain management education tools were created including: Development of Pain Management Algorithm for Nursing Scripting for Patient Education re: Blocks and Pain Plan Development of educational tool re: pain assessment/ reassessment Nursing Education was rolled out in April 2016 via in-person small group sessions As part of the orientation process to 12R, new nursing staff now attend the Total Joint Replacement Class During the Fall of 2016, Rosenberg 6 and 12 Reisman nursing teams created and implemented a patient education tool for staff to use when communicating with patients about pain management. (This is introduced to Total Joint Replacement patients during their PreOp class.) Results/Progress to Date Pain Assessment Documentation Assessment (Pain Score) documented within 15 minutes of med. administration? Reassessment (Pain Score) documented within 20-45 mins Post-IV or 30-90 mins Post-PO medication administration? The Team Gina Murphy, RN, MSN, 12R Jenny Barsamian, RN, MSN, 12R Caroline Torney, RN, BSN, 12R Molly MacKay, RN, BSN, 12R Danielle Francisco, RN, BSN, 12R Phyllis West, MSN, RN, ACN Deb Stepanian, Health Care Quality 12R Nursing Staff Pre-Education Post-Education Post- eFlowsheet Rollout Pre-Education Post-Education Post- eFlowsheet Rollout Discharge Date By the end of CY16, 12 Reisman gained a 2.2% increase in their Overall Pain Management Score, advanced by a 3.5% increase of patient’s responding staff ‘always’ did everything to help with their pain and 1% boost for patient’s pain ‘always’ well-controlled. Gina Murphy, RN, MSN, Nurse Director, gamurphy@bidmc.harvard.edu

Managing Pain and The Patients’ Perspective: A Collaborative Approach Beth Israel Deaconess Medical Center More Results/Progress to Date Staff Survey Response: I routinely discuss a plan for pain control with my total joint replacement patients at the start of every shift. Lessons Learned Next Steps Improved patient satisfaction with pain management Increased opportunities to help set expectations with patients Enhanced knowledge of staff Greater access to patient teaching tools Introduced new opportunities for cross-departmental teamwork Sustain Revisit DMS Metrics Continue auditing Educate new staff, refresh current staff Share Mentor other units in the design of their own pain management improvement work Gina Murphy, RN, MSN, Nursing Director, gamurphy@bidmc.harvard.edu