Pain Management at LUHS: A Focus on Physicians

1
Pain Management at LUHS A Focus on Physicians

• Pain Executive Committee
• Pain Management Committee

2
Opportunity Statement

• For the past 4 years there have been significant
  efforts to improve pain management for patients
  at LUHS.
• Despite efforts, patient satisfaction with pain
  management remains in the lower third of
  hospitals in the Press Ganey database
• Project Goal
• To increase physician awareness and provide
  education in an attempt to standardize physician
  documentation and ordering practices

3
Most Likely Causes

• The subjective nature of pain
• Concerns about addiction and regulatory sanctions
• Lack of formal education addressing pain
  management
• Limited physician guidelines and standing orders
  for pain management
• Little awareness of expectations for documentation

4
Solutions Implemented

• Education Awareness
• Pain lecture added to new house staff orientation
• Department specific data shared with the Clinical
  chairs
• Press Ganey scores
• Documentation audits
• Medication utilization
• Presentations LUPF General Membership,
  Department Grand Rounds, SSOM students

• Standard Orders Guidelines available on the EMR
  and LUCI
• Adult pain management
• Adult sickle cell pain management
• Ongoing participation in the review process of
  standard orders for appropriate pain management

5
Solutions Implemented

• Meperidine Guidelines
• Collaborated with PT Committee to establish
  guidelines for Meperidine use
• Treatment of rigors and postoperative shivering
• True allergy to all other opioids
• Short term use in young healthy patients for
  analgesia (limited to 48 hours of use, maximum of
  600mg in 24 hours)
• Compared utilization with UHC peers

• Documentation Review
• Continued documentation audits for the HP and
  daily Progress Note
• Implemented re-audit process

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Physician Pain Documentation Has Improved
7
LUHS Meperidine Utilization Has Decreased
8
No Change Has Been Noted In Inpatient Press Ganey
Scores
9
Next Steps

• Ongoing medical record audits
• Continue to monitor Meperidine utilization
• Work with Clinical Chairs to determine department
  specific priorities and encourage pain management
  initiatives in all departments
• Department specific education sessions for
  attendings and residents
• Implement a multi-disciplinary Pain Lecture
  Series for shared learning for all health
  professionals