Transcript Clinical team implements opioid prescribing

Clinical Integration
IMPROVEMENT BULLETIN
METRICS/DATA
Reducing variation on opioid prescribing
Sponsors: Mike Ayers, MD, Chief Joint Replacement; Owen McConville,
MD, Chair, Orthopedics; Tim Quigley, RN, Chief Nursing Officer, South
Shore Hospital
Team: Michael Marchetti, MD; Angelica Duczankowski, PA-C; Bernie
Hendriksen, PA-C; James Green; Lorraine Campbell, RN; Leslie Stenbeck,
RN; Gerda Sullivan, RN; Ann Marie Materna, RN; Ellen Howard, RN; Quay
Baker, RN; Edwina Brinkley, RN; Kim-Phung Lai, Rph; Richard Bello, MD
Measure
Number of physicians who
prescribe pain med pre-op
Number of physicians
prescribing pain med day of
surgery (DOS)
Background: There was significant variability among surgeons at 2 Pond
Park regarding Post-Operative Pain Management. At times this led to
complicated post operative instructions, occasionally confounding
nursing staff, and impeding patient/family education. With a growing
opioid drug problem on the south shore, concern was also expressed
regarding the ultimate disposition of prescribed but unused narcotics.
A Pain Management Committee was created to develop alternatives.
Source: Manual count
Goals: Develop and implement standardized pain management
guidelines segmented by procedure (e.g., knee arthroscopy, trigger finger
release, ACL reconstruction) to achieve:
Standardize on the number of
pain meds prescribed DOS
(Excludes complex cases)
Next Steps: Spread the standard across the Health System.
%
change
from
baseline
Target
March, 2014
(Baseline)
October, 2014
0
45%
18%
60%
100%
54%
82%
52%
100%
compliance
with standard
0%
no standard
95%
compliance
95%
100%
compliance
with standard
17%
92%
441%
NA
98%
96%
-2%
Source: Internal survey at 2 PP
Location: COSSM’s Ambulatory Surgery Center, 2 Pond Park,
Hingham MA
• 100% of pain meds prescribed on the day of surgery
• Standardize on:
• Types/combinations of pain meds
• Quantity of pain meds prescribed
• Materials and processes to inform patients and families on pain
management
• Education for patient and families regarding safe disposal and
use of narcotic medications
Health Provider Services Organization
Standardize on the combination
of pain meds prescribed DOS to
be Tylenol and/or Motrin and
Oxycodone (Eliminate Vicodin,
Percocet)
Source: Manual count/audit
Source: Manual count/audit
Patient Pain Management
Satisfaction rank score
Source: Press Ganey, Day Surgery
Pond Park, Ambulatory
Questions? Contact Lorraine Campbell at [email protected]
See page 2 for information on the process improvements that were made.
Clinical Integration
IMPROVEMENT BULLETIN
Health Provider Services Organization
The table below is a summary of the process improvements that were made. Click here to read the Patriot Ledger article related to this work.
Problem
Solutions
There was variability among Surgeons regarding
when they prescribed pain medication (pre-op
versus day of surgery). This often led to
confounding nursing staff, and impeding
patient/family education.
•
Collected data from 2 Pond Park to
assess variation
•
Created Post-Operative Pain
Management guidelines
There was variability among Surgeons regarding
the quantity/types/combinations of pain
medications prescribed sometimes confounding
nursing staff and impeding patient/family
education.
•
Collected data from 2 Pond Park to
assess variation
•
Created Post-Operative Pain
Management guidelines that limit
types of opioids
Some patients did not fully understand their pain
management/medication plan. As a result there
were numerous calls to the attending and/or oncall orthopedist.
•
Developed patient and family
education materials
•
Ensured all staff was familiar with the
materials and could share these at
anytime with patients and families
•
Encouraged physicians to start
opioid/pain management education
for patients in their office versus
during pre-op or DOS
Find more bulletins on the Clinical Improvement Corner on the Medical Staff website.
Email us at: [email protected].
For internal distribution only.
Rev 2/15/15
Results
•
•
Next Steps
Post-Operative Pain Management
•
guidelines developed:
• Reduced the number of pills
prescribed pre-op to be 20 -60
procedure specific
•
• Standardized on prescribing day of
surgery versus pre-op
Post-Operative Pain Management
•
guidelines developed:
• Establish DOS prescriptions should
be a combination of Tylenol and/or
Motrin and Oxycodone (Eliminated
Vicodin and Percocet)
• Dilaudid if allergic
•
Developed Opioid Education/Teaching
leaflet being provided to every patient
at discharge
•
Safe Disposal of Medications flyer
created and available in waiting room
for families
•
Continue to monitor and
improve guidelines at 2 Pond
Park
Spread the guidelines across
the SSH Health System
Spread the guidelines across
the SSH&EC Health System
Work with staff to improve
process for using the patient
and family education materials