Patient Sensitive Pain Management at LUHS Team: Pain Management Committee

Opportunity Statement To improve pain management for patients at LUHS to ensure they will receive the best pain control that can safely be provided

Pain Management Objectives FY05 Improve inpatient satisfaction scores related to pain Review and maintain EMR orders and guidelines Formalize patient education program Provide MD and staff education Conduct chart audits and share results

Changes were made to the Pain Management Committee Co-Chairs: K. Candido MD T. Kristopaitis MD Ten Physicians: Anesthesia, Emergency, Hem/Onc, Medicine, Pediatrics, Rheumatology, Surgery Twelve Nurse Leaders: Administration, Inpatient, Ambulatory, Cancer, Pain, Staff & Patient Education, Staff RN’s Others: Ethics, Pastoral Care, Pharmacy, Psychiatry, & CCE

Conducted Patient Focus Groups & Developed an Action Plan Set appropriate expectations with patients Involve the patient & individualize Offer options Improve PCA management Standardize “transition” to oral medications Consider PCA service Analyze Vicodin use and identify options Standardize orders to address breakthrough pain Physician & Staff Education programs               

Chartered subcommittees to address priorities Pain Resource Nurse program Pediatric Pain committee Pain Patient Education committee Order & Guideline Review committee Pain Education Newsletter committee

Other Activities Proposed a patient TV relaxation channel Initiated review of standard orders Documentation audits Provided PCA workshops

Physician pain documentation has improved 95% 83% 86% 77% 70% 78% 92% 65% 0% 10% 20% 30% 40% 50% 60% 80% 90% 100% Baseline n=16 Re-Audit n=16 Re-Audit 2 n=14 Re-Audit 3 n=12 Re-Audit 4 n=5 Percent Compliance H&P Daily Progress Note

assessment documentation has improved Percent Complete Nursing pain re - assessment documentation has improved Confidential: For Quality Improvement Purposes Oct 03 Nov 03 Dec 03 Jan 04 Feb 04 Mar 04 Apr 04 May 04 Jun 04 Jul 04 Aug 04 Sep 04 Oct 04 Nov 04 Dec 04 50 60 70 80 90 100 UCL = 106.34 Mean = 85.07 LCL = 63.79

There is a continued opportunity to improve inpatient satisfaction Mean Score Inpatient Press Ganey Scores How Well Your Pain Was Managed & Controlled Confidential: For Quality Improvement Purposes J - S 97 O D 97 M 98 A J 98 S 98 D 98 M 99 J 99 S 99 D 99 M 00 J 00 S 00 D 00 M 01 J 01 S 01 D 01 M 02 J 02 S 02 D 02 M 03 J 03 S 03 D 03 M 04 J 04 S 04 D 04 70 72 74 76 78 80 82 84 86 88 90 UCL = 85.93 Mean = 82.1 LCL = 78.25 UCL = 86.66 Mean = 82.6 LCL = 78.61 UCL = 86.47 Mean = 83.1 LCL = 79.75 How Well Your Pain Was Controlled Pain Project Implemented Jan 00 PRN Program Implemented Jan 02

Next Steps Implement focus group action plan Implement relaxation TV channel Review and update all pain management orders Implement a comprehensive patient education program Distribute pain newsletter Explore documentation improvement efforts with EPIC