nicheprogram.org 16th Annual NICHE Conference Forging New Paths and Partnerships 1

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1 A Multidisciplinary Effort to Improve Patient Care and Satisfaction With Pain Management Megan Begnoche, MSN, RN, CNS, AOCN Martha Watson, MS, RN-BC, GCNS Objectives: 1. Describe the mission of the Pain and Palliative Care Steering Committees. 2. Identify strategies, evidence based interventions and collaborative planning methods used. 3. Review quality outcome measures impacted by these initiatives. The Miriam Hospital Located in Providence, RI NICHE Member Four-time time, consecutive Magnet designee Private, not for profit Academic medical center Specialties in Cardiology, Orthopedics, Oncology, Bariatrics 247 Beds, acute adult care 58,800+ ED visits in FY

2 Mission: Pain Management and Palliative Care Steering Committee of The Miriam Hospital To coordinate a comprehensive, proactive approach to Pain Management To ensure evidence based practice and standards of care are used consistently and appropriately To coordinate a multidisciplinary approach across ALL hospital settings Membership: Started in 2009 Co-Chaired Chaired by: MD, Palliative Care Medicine RN Director of Cancer Services & Ambulatory Care Steering Committee Meets Quarterly Multidisciplinary membership includes team members from: RN, Director of Quality Management DPT, Rehabilitation Services MD, Pharmacy MD, Psychiatry MD, Anesthesiology MD, Interventional Pain Medicine RN, Inpatient Nurse Manager RN, Emergency Department Quality Management RN, Quality Management RN, Emergency Department RN, Inpatient Nursing RN, Outpatient Hematology/Oncology RNP, Hematology/Oncology RNP, Palliative Care CNS, Hematology/Oncology CNS, Geriatrics 2

3 Identified Gap: Process Analysis and Root Cause Identification The Steering Committee looked at the changing hospital patient population and the body of literature predicting future demographics: Geriatrics Acute on Chronic Pain Populations Environment of Care New Bariatric Surgical Program - OSA Communication To families At handoffs among caregivers RN/MD Formal Education Related to Pain Overall Plan of Action: Recommended Improvements: Hospital wide clinician education Evidence based tools for clinicians Increase patient and family awareness Provide consistent feedback to all care providers about initiatives Identify opportunities to make changes in the environment Clinician Education: MD/LIP: Grand Rounds Regular department specific meetings Education of Medical Residents at Noon Rounds Consultation/Collaboration with Palliative Care Team and Psychiatric Consultation Service Nursing: RN Pain Resource Nurse Education 2X year Resource Nurse Team monthly Education of Pain Assessment Tool Support of ANCC Certification in Pain GENESIS Pain Protocol GENESIS Model C.N.A Use of NICHE GPCA modules AGA Education 3

4 Evidence Based Tools: Pain Management Order Sets Acute Pain Chronic Pain Participation in National Research Study Robert Wood Johnson Foundation Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes Increase Patient and Family Awareness: Use of SBARP Redesigned Pain Brochure Pain Plan on communication white boards in rooms Discussions of pharmacologic and non-pharmacologic plans with patients and families Consistent Feedback About Initiatives: Pain Satisfaction Committee Multidisciplinary Resource Nurse Team PRN and GRN and PUP Magnet structure of shared governance to disseminate information to councils 4

5 Changes In The Environment: Med Calm Channel Comfort Kits Environment of Care RESULTS: Qualitative and Quantitative: So how did we do? Press Ganey Inpatient 5

6 Surgical & Medical Improvement Combined Feb 2012 to Jan 2013: NDNQI Pain Research Results 6

7 Patient Pain Brochure from the Resource Nurse Team: Pain Comfort Bundle: Future Goals: To Increase Palliative Care Consults on all inpatient units. To improve HCAPS performance from 70th percentile to the 90th percentile for To continue to regularly assess strategies, interventions based on new evidence and to sustain the hospital culture of excellence in pain management. 7

8 Meet Our Team! Inspire one another to improve the health and spirit of the lives we touch Mission Statement of The Miriam Hospital THANK YOU 8