Transcript Pain Management - Loyola Medicine

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
1. Improve inpatient satisfaction
scores related to pain
2. Review and maintain EMR orders
and guidelines
3. Formalize patient education
program
4. Provide MD and staff education
5. 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
1. Set appropriate expectations with patients
– Involve the patient & individualize
– Offer options
2. Improve PCA management
– Standardize “transition” to oral medications
– Consider PCA service
3. Analyze Vicodin use and identify options
4. Standardize orders to address breakthrough
pain
5. 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
100%
95%
86%
90%
77%
Percent Compliance
80%
70%
78%
70%
60%
83%
65%
92%
83%
65%
50%
40%
30%
20%
10%
0%
Baseline n=16
Re-Audit n=16
H&P
Re-Audit 2 n=14 Re-Audit 3 n=12
Daily Progress Note
Re-Audit 4 n=5
Nursing pain
Nursing
painrere-assessment
-assessment documentation
documentation
has
has
improved
improved
UCL = 106.34
100
90
Mean = 85.07
Percent Complete
80
70
LCL = 63.79
60
50
Confidential: For Quality Improvement Purposes
There is a continued opportunity to
improve inpatient satisfaction
Inpatient Press Ganey Scores
How
Well
Your
Pain
Was Controlled
How Well Your
Pain Was
Managed
& Controlled
90
88
UCL = 86.66
86
UCL = 86.47
UCL = 85.93
84
Mean Score
82
Mean = 82.6
80
Mean = 82.1
Mean = 83.1
LCL = 79.75
LCL = 78.61
LCL = 78.25
78
76
74
72
Pain Project
Implemented
Jan 00
70
Confidential: For Quality Improvement Purposes
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