1. Patient Sensitive Pain Management at LUHS
Team:
Pain Management Committee

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

3. 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

4. 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

5. 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               

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

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

8. 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

9. 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 =
Mean = 85.07
LCL = 63.79

10. 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

11. 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