It can be one of the biggest challenges in caring for hospitalized patients — managing their pain.
In 2017, in response to the opioid crisis, Nebraska Medicine’s pain management work group revised pain medication order sets to help providers prescribe pain medicine in a responsible way. The team also partnered with the Pain Resource Network (PRN) to educate frontline staff on alternatives to pain medication, including heat/cold, music and guided imagery.
“We saw that when we prescribe more appropriate regimens for pain, we can simultaneously decrease our use of opioids and improve our patients’ pain control,” said Sarah Richards, M.D., assistant professor of internal medicine at UNMC and medical director of patient experience at Nebraska Medicine.
The data shows the new orders and alternative techniques are working well, with a decline in the amount of medications and the number of interventions and safety events, while improving patients’ pain control.
From July 1, 2016 to March 31, 2019, the number of opioid medication orders per 1,000 patient days decreased overall by 35%.
Today, another important focus has come into view — how often we talk to our patients about their pain.
“When uncontrolled pain is ignored by even one provider, it can have a negative impact on the patient’s entire hospital experience,” said Jason Shiffermiller, M.D., assistant professor of internal medicine.
In 2018, questions regarding pain changed on the inpatient surveys patients receive after they are discharged.
These two questions:
- During this hospital stay, how often was your pain well controlled?
- During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
Changed to the following questions in 2018:
- During this hospital stay, how often did hospital staff talk with you about how much pain you had?
- During this hospital stay, how often did the hospital staff talk with you about how to treat your pain?
(Answer choices are never, sometimes, usually and always).
“What is the best way to communicate to our patients about their pain?” Dr. Richards asked. “Some patients won’t admit they are in pain, some are afraid of becoming addicted to medication and some fear the perception of needing help with their pain. It’s important for all care team members to be mindful of this.”
“The PRN members have been champions on all the inpatient units to educate those at the bedside and demonstrate techniques for pain reassessment,” said Peggy Mazzeo, care transitions nurse and PRN co-chair.
“Those reassessments are important and directly correlate to a patient’s perception that their health care team cares about their pain,” Dr. Richards said.
The data demonstrates this work is having a positive impact on patients.
“When the team started this work in 2016, our pain scores were in the 10th to 20th percentile when compared to like-size hospitals,” Dr. Richards said. “Since then, our pain scores have climbed significantly, to the 83rd percentile thus far in fiscal year 2019.”
Now the challenge becomes how to sustain the momentum.
“We created a tool that physicians can use to educate their students and residents on how to talk to their patients about their pain,” Dr. Shiffermiller said.
Providers can find the information on Apollo by clicking this link. Search for “Provider Pain Management.” If the window does not open, change your settings to allow for pop-up windows. There is a separate training for nurses called “Nurses Pain Management.”
Learn more in this brief video featuring Sarah Richards, M.D., and Jason Shiffermiller, M.D.