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Matt Morse Matt Morse , Institute for Healthcare Improvement (IHI), - - PDF document

4/10/2012 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


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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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WebEx Quick Reference

  • Welcome to today’s session!
  • Please use Chat to “All

Participants” for questions

  • For technology issues only,

please Chat to “Host”

  • WebEx Technical Support:

866-569-3239

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Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text

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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. 6

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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

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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 Managem ement 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

  • f 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
  • rder 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

  • rder

 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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