Pain Management at Pain Management at LUHS: LUHS:

A Focus on PhysiciansA Focus on Physicians

Pain Executive CommitteePain Management

Committee

Loyola University Chicago

LOYOLAUNIVERSITYHEALTH SYSTEM

Opportunity StatementOpportunity 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:Project Goal:To increase physician awareness and provide education in an attempt to standardize physician documentation and ordering practices

Most Likely CausesMost Likely Causes

The subjective nature of painConcerns about addiction and regulatory sanctionsLack of formal education addressing pain managementLimited physician guidelines and standing orders for pain managementLittle awareness of expectations for documentation

Solutions ImplementedSolutions Implemented

Education & AwarenessEducation & AwarenessPain lecture added to new house staff orientationDepartment specific data shared with the Clinical chairs

Press Ganey scoresDocumentation auditsMedication utilization

Presentations: LUPF General Membership, Department Grand Rounds, SSOM students

Standard Orders & Standard Orders & Guidelines available Guidelines available on the EMR and on the EMR and LUCILUCI

Adult pain management Adult sickle cell pain managementOngoing participation in the review process of standard orders for appropriate pain management

Solutions ImplementedSolutions Implemented

Meperidine GuidelinesMeperidine GuidelinesCollaborated with P&T Committee to establish guidelines for Meperidine use

Treatment of rigors and postoperative shiveringTrue allergy to all other opioidsShort 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 Documentation ReviewReview

Continued documentation audits for the H&P and daily Progress NoteImplemented re-audit process

Physician Pain Physician Pain Documentation Has Documentation Has ImprovedImproved

Physician Pain DocumentationFor Services That Were Re-audited

58%51%

73%

55%

0%

20%

40%

60%

80%

100%

History & Physical Daily Progress Notes

Co

mp

lian

ce

Initial Reaudit

LUHS Meperidine LUHS Meperidine Utilization Has DecreasedUtilization Has Decreased

Meperidine Utilization January 2001-September 2002

11.4%13.5%

14.9% 14.5% 13.9%12.9%

12.1% 11.9%

10.60%

8.70%8.50%

9.70%10.50%

9.50%9.7%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Q1-2001 Q2-2001 Q3-2001 Q4-2001 Q1-2002 Q2-2002 Q3-2002 Q4-2002

Quarter

Per

cen

t P

atie

nts

Rec

eive

d

LOYOLA

UHC

No Change Has Been No Change Has Been Noted In Inpatient Press Noted In Inpatient Press Ganey ScoresGaney Scores

"How Well Your Pain Was Controlled"

13

30

16

510

3 411 9

38

20

10

34

2218

31

13

29

83.9 85.6 85.2 83.280.5 81.5

78.8 79.9 81.2 81.183.7 82.5 81.2 83.7 82.6 82.6 83.6 81.2 83.2 82.4 83.3 83.7 81.9

29

19

28 29

12

0

10

20

30

40

50

60

70

80

90

100

J-S97

O-D97

J-M98

A-J98

J-S98

O-D98

J-M99

A-J99

J-S99

O-D99

J-M00

A-J00

J-S00

O-D00

J-M01

A-J01

J-S01

O-D01

J-M02

A-J02

J-S02

O-D02

J-M03

Quarter

Sco

re

Pain Project Structure Implemented

LUHS MEAN SCORE

LUHS PERCENTILE RANK

Next StepsNext Steps

Ongoing medical record auditsContinue to monitor Meperidine utilizationWork with Clinical Chairs to determine department specific priorities and encourage pain management initiatives in all departmentsDepartment specific education sessions for attendings and residentsImplement a multi-disciplinary Pain Lecture Series for shared learning for all health professionals