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Session Six

Connections: Pain Management

Kelly McCutcheon Adams, MSW, LICSW, IHI Director

Barbara Balik, RN, EdD, IHI Faculty

March 21, 2012

2:00 – 3:00pm EST

Matt Morse

Matt Morse, Institute for Healthcare Improvement

(IHI), is responsible for managing and

coordinating a variety of programs based on Key

Processes on the IHI Improvement Map. Mr.

Morse is a graduate of Northeastern University in

Boston, MA and has been with the IHI for 4 years.

He enjoys music, travel, cooking, and some

graphic design.

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Kelly McCutcheon Adams, MSW, LICSW

Kelly McCutcheon Adams, MSW,

LICSW, Director, Institute for Healthcare

Improvement (IHI), has served in this

capacity for eight years for a variety of IHI

Collaboratives and programs, particularly

those focused on critical care. She is a

medical social worker with experience in

hospice, nursing home, sub-acute

rehabilitation, emergency department, and

ICU settings. She has also served as

faculty for the US Department of Health

and Human Services Organ Donation

Collaborative and for the Gift of Life Institute.

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Barbara Balik, RN, EdD

Barbara Balik, RN, EdD, Principal, Common

Fire Healthcare Consulting, is also Senior

Faculty at the Institute of Healthcare

Improvement. Her areas of expertise include

leadership and systems for a culture of quality

and safety, including patient- and family-

centered care, patient experience, systems to

improve transitions in care, and transforming

care prior to or with optimization of an electronic

health record implementation. She works with

leaders to develop adaptive systems to excel

and innovate in complex organizations, and to

ensure sustained improvement and innovation

every day. Ms. Balik's publications include the

book, The Heart of Leadership, and the IHI white

paper on “Achieving an Exceptional Patient and

Family Experience of Inpatient Hospital Care,”

among others. Previously, she served in senior

leadership roles at Allina Hospitals and Clinics,

United Hospital, and Minneapolis Children's Medical Center.

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Overall Objectives

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At the end of this program, participants would be able to:

• Articulate key foundational elements in support of all

domains of patient experience improvement

• Share specific testable ideas for improving nurse

communication, pain management, and cleanliness

• Plan small tests of change to try during the Expedition

Session Agenda

• Homework – We did you learn?

• Patient Experience Change Package

─ Our focus today

• Perspectives from Faculty:

─ Roslyn Marshall, Nurse Manager, Neuroscience

Center, Medical College of Georgia Health System

• Perspectives from the Field:

─ Sara Short, HCAHPS Rep, and Kimberly Chumley,

Director, Mother/Baby Unit, Reston Hospital Center

─ JoAnne Cattell, CNO, St. Petersburg General Hospital

• Time for Q&A 8

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Homework from prior session

• Identify 1 lesson from the field in Nursing

Communication to test in the next 5 days

• Share what you learned from the test at the

next session

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Patient Experience Change Package: Overview

Key areas for improving specific domains of

patient experience: Nurse Communication,

Cleanliness, and Pain Management

Staff and Physicians Patient and Family Connection

Leadership Engagement Improvement/

Infrastructure

Foundational Elements for Improving Patient Experience

Today’s Session

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Our Focus Today

• Why the Connection?

─Cycle of Communication between all staff and

physicians and patients/families is core to

patient experience

─Examples of where Connection shows up in

HCAHPS results:

Nursing Communication

Cleanliness

Pain Management

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Lessons from Faculty

• Roslyn Marshall, Nurse Manager,

Neuroscience Center, Medical College of

Georgia Health System

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Pain Management

Key Change Concepts

• Introductions and Understanding Patient Comfort Definitions

─ Process to understand patient definition of comfort preferences including light,

heat, noise. Create reliable system for these definitions and preferences being

shared across shifts and disciplines

• Pain Management

─ Mutually develop comfort goals that include pain management, medications,

environment, and activity level for hospital stay and for self-management post-

hospitalization.

• Shared Care Plan

─ Consider the care plan a shared document. Assure opportunities for patient input

into the plan and review the care plan together

• Pain Management Expertise

─ Develop or identify a specialized expert resource to consult with staff and care

team regarding difficult pain management issues and train staff on current

methods

• Pain Management Escalation Pathway

─ Develop a policy or procedure for staff to follow when a patient has difficult pain

management. Develop staff understanding of role of personal bias in

addressing challenging pain issues with patients.

Lessons from the Field

• Sara Short, HCAHPS Rep, Mother/Baby

Unit, Reston Hospital Center

• Kimberly Chumley, Director, Mother/Baby

Unit, Reston Hospital Center

• JoAnne Cattell, CNO, St. Petersburg

General Hospital

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Reston HCAHPS data: Top Box answers for

Pain Management Domain

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St. Petersburg HCAHPS data: Top Box

answers for Pain Management Domain

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Pain Management Reston Hospital Center, Pilot Unit (Mother/Baby)

•Implemented use of a tool that promotes clear communication between nurse and patient.

•Developed script and process that requires use of tool on admission, each shift assessment, and each new complaint of pain.

•Use tool during hourly rounds to proactively manage pain.

•Shared Pain Assessment Tool with other inpatient units. PDSA’s encouraged to customize process to different patient populations.

•Ongoing data collection regarding pain reassessment in order to give feedback to staff regarding pain management goals.

Reston Hospital Center Faces Pain Scale

Descriptive Words

Ache Burning Cramps Dull Heavy Intermittent

Minimal Numbing Pin Pricks Pressure Sharp Shooting

Soreness Stabbing Throbbing Tingling Vague

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St. Petersburg General Hospital Pain Management Plan

Pain Management Plan

Opportunity Recognized need for improvement in educating patients

regarding their pain management plan

Adequate pain control for those in need

Commitment All patients will be informed within 24 hours of admission.

There will be a consultative process for those that are not receiving adequate comfort from the pain management plan

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Pain Management Plan

Old process

Fragmented

Information not user-friendly

Delays in receiving orders

Inconsistent and limited use of the Pain Team for consults

When you’re in pain nothing else matters!

SPGH Pain Management Plan

Education for our patients Two sided 6 X 8 in ‘Managing

Your Pain’ card was developed.

PDSA test cycles showed increased patient satisfaction.

Consultative Services Team consists of Nursing,

Pharmacy, Rehab, Anesthesiologist

Anyone can make the consult Does not require a physician

order Recommendations are

followed up with the managing physician

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Homework for the next session

• Identify 1 lesson from the field in Pain

Management to test in the next 5 days

• Share what you learned from the test at

the next session

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Next Call

Session 7 - Cleanliness

Date: Wednesday, April 4, 2012

2:00 PM - 3:00 PM Eastern US time

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Listserv

• Patient_experience@ls.ihi.org

• Send and receive questions and

comments to/from faculty and participants

• To be added to the listserv please email

dkim@ihi.org

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