Pain Management at LUHS: A Focus on Physicians

1. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Pain Management at LUHS: A Focus on Physicians Pain Executive Committee Pain Management Committee

2. Opportunity Statement • For the past 4 years there have been significant efforts to improve pain management for patients at LUHS. • Despite efforts, patient satisfaction with pain management remains in the lower third of hospitals in the Press Ganey database Project Goal: • To increase physician awareness and provide education in an attempt to standardize physician documentation and ordering practices

3. Most Likely Causes • The subjective nature of pain • Concerns about addiction and regulatory sanctions • Lack of formal education addressing pain management • Limited physician guidelines and standing orders for pain management • Little awareness of expectations for documentation

4. Education & Awareness Pain lecture added to new house staff orientation Department specific data shared with the Clinical chairs Press Ganey scores Documentation audits Medication utilization Presentations: LUPF General Membership, Department Grand Rounds, SSOM students Standard Orders & Guidelines available on the EMR and LUCI Adult pain management Adult sickle cell pain management Ongoing participation in the review process of standard orders for appropriate pain management Solutions Implemented

5. Meperidine Guidelines Collaborated with P&T Committee to establish guidelines for Meperidine use Treatment of rigors and postoperative shivering True allergy to all other opioids Short term use in young healthy patients for analgesia (limited to 48 hours of use, maximum of 600mg in 24 hours) Compared utilization with UHC peers Documentation Review Continued documentation audits for the H&P and daily Progress Note Implemented re-audit process Solutions Implemented

6. Physician Pain Documentation Has Improved

7. LUHS Meperidine Utilization Has Decreased

8. No Change Has Been Noted In Inpatient Press Ganey Scores

9. Next Steps • Ongoing medical record audits • Continue to monitor Meperidine utilization • Work with Clinical Chairs to determine department specific priorities and encourage pain management initiatives in all departments • Department specific education sessions for attendings and residents • Implement a multi-disciplinary Pain Lecture Series for shared learning for all health professionals