1. Patient Sensitive Pain Management at LUHS Project Committees: Pain Executive Committee Pain Management Committee Pain Resource Nurse Planning Committee Pain Resource Nurses Loyola University Chicago LOYOLA UNIVERSITY HEALTH SYSTEM

2. Opportunity Statement For the past five years there have been significant efforts to improve pain management for patients at LUHS. The overall goal is to ensure that all patients receive the best pain management that can safely be provided. FY2004 Objectives: 1.Address the unique needs of special populations 2.Improve pain assessment, management and documentation by MD’s & RN’s 3.Implementation of the LUHS Pain Talking Points

3. Barriers to optimal pain management: The subjective nature of pain Concerns about addiction and regulatory sanctions Lack of uniform education addressing pain management Little awareness of expectations for documentation Variation in physician ordering practices Limited staff involvement in organizational quality improvement efforts to improve pain

4. #1: Addressed the needs of special populations Implemented pain scales for all patient populations: Created Pediatric pain subcommittee Standard order sets on the EMR for Pediatric PCA and Epidural management SCALE:POPULATION: N-PASSTerm and preterm infants FLACCPreverbal children VAS/FacesVerbal children and adults *added considerations for the elderly Pain BehaviorsPatients that are unable to communicate

5. #2 RN’s: Improve pain assessment, management, and documentation Monthly Pain Resource Nurse meetings Pain Education Day with well known expert Margo McCaffery RN, MS, FAAN There is an opportunity to improve pain documentation

6. #2 MD’s: Improve pain assessment, management, and documentation Reviewed all standard orders Presentations: Grand rounds House staff orientation SSOM students Physician pain documentation has improved

7. #2 MD’s: Meperidine use has decreased after guideline implementation Implemented Guidelines For Meperidine Use December 2002 UHC Utilization Rate Loyola Utilization Rate Percent of Patients LUHS Meperidine Utilization January 2001-December 2003 Q1 - 2001 Q2 - 2001 Q3 - 2001 Q4 - 2001 Q1 - 2002 Q2 - 2002 Q3 - 2002 Q4 - 2002 Q1 - 2003 Q2 - 2003 Q3 - 2003 Q4 - 2003 0 2 4 6 8 10 12 14 16 18 20 UCL = 15.00 Mean = 13.1 LCL = 11.28 UCL = 10.39 Mean = 5.3 LCL = 0.16 Percent of Patients LUHS Meperidine Utilization January 2001-December 2003 Q1 - 2001 Q2 - 2001 Q3 - 2001 Q4 - 2001 Q1 - 2002 Q2 - 2002 Q3 - 2002 Q4 - 2002 Q1 - 2003 Q2 - 2003 Q3 - 2003 Q4 - 2003 0 2 4 6 8 10 12 14 16 18 20 UCL = 15.00 Mean = 13.1 LCL = 11.28 UCL = 10.39 Mean = 5.3 LCL = 0.16 Implemented Guidelines For Meperidine Use December 2002 UHC Utilization Rate Loyola Utilization Rate

8. #3 Pain Resource Nurses implemented the LUHS Pain Talking Points Pain Talking Points 1.Controlling your pain is a priority at Loyola 2.Explain the pain scale 3.Individualize pain management 4.Request pain medication before the pain gets worse 5.Pain medication is not the only thing that can relieve your pain Source: Patient Interviews

9. There is a continued opportunity to improve inpatient satisfaction with pain management Mean Score Inpatient Press Ganey How Well Your Pain Was Managed & Controlled J-M 99 A-J 99J-S 99 O-D 99 J-M 00 A-J 00J-S 00 O-D 00 J-M 01 A-J 01J-S 01 O-D 01 J-M 02 A-J 02J-S 02 O-D 02 J-M 03 A-J 03J-S 03 O-D 03 70 72 74 76 78 80 82 84 86 88 90 UCL = 82.47 Mean = 80.3 LCL = 78.03 UCL = 86.66 Mean = 82.6 LCL = 78.61 UCL = 86.47 Mean = 83.1 LCL = 79.75 Pain Project Structure Implemented Jan 00 PRN Program Implemented Jan 02

10. Next Steps Maintain ongoing readiness for JCAHO survey Evaluate project committees and reorganize Review and standardize patient education materials Monitor patient satisfaction, documentation and Meperidine utilization Implement a multi-disciplinary Pain Lecture series for all health professionals Encourage pain management initiatives in all departments