developing nursing managers and clinicians to lead ... 6 slides pt...hospice, nursing home,...
TRANSCRIPT
4/10/2012
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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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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.
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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 8
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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 Management
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 of 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 order 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
order 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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