Narcotic Epidemic Our response. Kathleen Urquico, RN Nurse Navigator Ortho Surgery
Conflict of Interest I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect my views on the subject which I am presenting.
Outcome Adopt appropriate interventions and metrics in the clinical setting to assist the state in its efforts to address Opioid crisis.
Objectives Discuss pain management initiatives Describe outcome metrics used Share best practices and future plans.
Rubin Institute for Advanced Orthopedic Opened in 2000 Dedicated OR 17 Bed Inpatient, P.T. Gym 3 Surgeons 800-1200 of surgeries per year Rehabilitation Center Acute Care Rehab Pain Management Services Physical Therapy Out Patient Rehab
Care Coverage 47 % Baltimore City 16 % Baltimore County 27 % Nearby Counties 9 % Nearby states 1 % other states https://commons.wikimedia.org/wiki/file:map_of_maryland_counties.jpg
Patient Demographics Case Mix 67% Primary hip and knees 33% Revisions 69% Female Average age 34% 56-64y 23% 66-78y 22% 46-55y
Scenario 1 Friday, 5pm. Patient at 1 week postop, calls nurse line requesting for pain medications, he is likely to run out by Saturday night.
Scenario 2 Patient comes in for 2 week post-op follow up visit. States his pain is well controlled, doing very well in P.T. and reports using ice around the clock and pain meds only as needed.
Scenario 3 Patient calls nurse line stating I am in a lot of pain. Hangs up the phone in the middle of patient interview. Presents himself in clinic requesting for a prescription.
Pre-implementation outcomes (2015) LOS 2.65 days D/C home 63% HCAHPS Pain Management 81%(2014) 71% (2015) JE Class Attendance Rate n/a Rx line calls n/a Patient Satisfaction (HL) n/a
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Improve patient satisfaction on a pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Improve patient satisfaction on pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
Action List Multi Disciplinary Meeting Use of pre-op questionnaire Pre-op assessment/chart review
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Improve patient satisfaction on pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
Action List Multi modal pain approach acute pain and chronic pain category PDMP Patient education on pain management Discharge instructions (written/verbal) Dedicated Nurse Line and Rx line (M-F) 8-5 for Rx refill, clinical questions Post-op guided referral to pain management specialist.
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Patient satisfaction on pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
Action List Pain Contract Joint Effort Class Joint Coach Early Ambulation Patient Engagement tool (Healthloop)
Patient engagement tool Interactive patient-provider software platform Total joint arthroplasty patients Enrolled 14 days prior to surgery Continues through 21 days postsurgery
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Patient satisfaction on pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
MDC Meeting Action List Clinical Pharmacist Specialist, Orthopedic floor PA-C Discharge Planning/Rounds Discharge Disposition Work closely with SNF and PM Specialist
Strategic Vision Improve Quality of Patient Care by identifying care opportunities to better manage pain Patient satisfaction on pain management protocol while maintaining safety Increase level of patient engagement and accountability Improve Inter-professional Collaboration Decrease Silos through care coordination and navigation
Action List Pre-op huddle Patient navigation tool Care Coordination Team
HealthCare Team Surgeon Anesthesiologist Fellow/Residents Clinical Team Administrative Assistant Schedulers Admin.Team Patient Allied Team Nurses PT/OT Case manager Clin. Ph. Specialist PA-c, NP
Patient s Journey
Key Factors for Success Pain Relief Safety
Performance outcomes (2016) LOS 2.78 days D/C home 59% Pain Management 74% 80% (Q1 and Q2 2017) JE Class Attendance Rate 41% 81%ytd Patient Satisfaction (HL) 93% Rx line calls 30% CCT Calls - 50 %
Patient Testimonial (retrieved from Healthgrades.com, 2017) When Dr. D. and I met, I was addicted to Opioids. He told me sternly that I would not be a candidate for knee surgery being addicted. He told me to get off anyway I knew how. I eventually did. I got all of the tests required before surgery. The surgery went very well. He has an excellent team. My Post-Op appointment required removing stitches. He removed them and we talked about my prognosis. I am recuperating well. - Patient from Baltimore, MD
Journey continues Research on outcomes Satellite offices Pain contract - 90 to 60 days Patient Engagement tool
Follow-up questions Kathleen B. Urquico, RN Email address: Kurquico@lifebridgehealth.org
Thank you!