Pain Rounds: Implementing an Interdisciplinary Team-Based Approach to Pain Management for Inpatient Rehabilitation

Abstracts from the Kaiser Permanente2018 National Quality Conference

 

Brian Theodore, PhD; Ryan Doan, MD

https://doi.org/10.7812/TPP/18-071-38

From Northern California

Background: Kaiser Permanente (KP) is renowned for excellent pain management across the system. In the inpatient rehabilitation setting, patients with acquired brain injuries and spinal cord injuries can often suffer from moderate or greater pain. To address the needs of the patient for timely, safe, and more effective pain management, the leadership at Kaiser Foundation Rehabilitation Center (KFRC) piloted an interdisciplinary team-based Pain Rounds program in 2017 as one of our departmental quality-improvement projects.
Methods: Population: Patient satisfaction levels with pain care during inpatient rehabilitation remained below our desired benchmark (ie, only 70% of patients reported that their pain was well controlled). Intervention: Pain Rounds are conducted 2 times/wk for patients who report a 24-hour average pain rating of > 4 on the pain numeric rating scale. The team is led by a physiatrist and includes nurse and neuropsychology team members. In addition to prescription painkillers, other interventions offered include guided imagery, meditation, heat/ice, massage, a transcutaneous electrical nerve stimulation unit, and aromatherapy. Comparison: Comparison of patient satisfaction pre- and postimplementation of Pain Rounds. Outcome measures: Patient satisfaction with pain management and longitudinal pain ratings.
Results: Pain Rounds was piloted in a single unit at KFRC occurring 2 times/wk. After successful implementation and documentation of protocols, we expanded it at the end of Q4 2017 to other units within KFRC and increased coverage to include any patient identified by nurses to have poorly controlled pain (even if 24-hour average pain rating < 4). In addition, a dot phrase was designed to be implemented into KP HealthConnect to better document pain ratings, interventions used, and patient satisfaction. During the pilot phase, we successfully elevated patient satisfaction levels from a baseline of 71% to a high of 80% (a 13% increase over baseline), exceeding the departmental target of 77.6% satisfaction. Data collection for the expanded phase of Pain Rounds is ongoing.
Discussion: We have developed a successful pilot for timely, adequate, and safe interdisciplinary team-based pain management for patients undergoing inpatient rehabilitation at KFRC. Next steps include 1) evaluating the usability of the implementation of the dot phrase into KP HealthConnect, 2) identifying the most useful interventions that have resulted in satisfactory pain control, and 3) finalizing and disseminating our Pain Rounds model throughout the Region.

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