Presented at the 2012 AAPM Annual Meeting « Back

A Systematic, Comprehensive Approach to Improve Pain Outcomes Throughout a Hospice Population

J. Cameron Muir, MD, cmuir@capitalcaring.org¹, Matthew G. Kestenbaum, MD¹, Brad Beukema, MS, Barry Hess¹, Stephen R. Connor, PhD¹, Malene Davis, MBA MSN RN¹, Perry G. Fine, MD², (1) Capital Caring, Falls Church, Virginia, (2) University of Utah, Salt Lake City, Utah

Pain prevalence in the advanced disease patient population has been well documented. Characterization of pain in the hospice population and systematic efforts to both measure and improve pain outcomes in the hospice population are limited. For self-assessment and quality improvement, we established uniform processes to measure and improve pain outcomes in a highly heterogeneous 1000+ census hospice population across seven communities around metropolitan Washington DC. Through adaptation of the electronic health record (EHR), we will report on how we were able to systematically record pain intensity levels for all hospice patients at every single clinical encounter using either a patient self report through numeric self rating (NSR) or, for those patients who were cognitively impaired, using the PAIN-AD tool. We determined that 52% of patients were able to self-report, while 48% of hospice patients were cognitively impaired such that pain determination had to be through behavioral assessment using the PAIN-AD tool. In addition, we launched a comprehensive pain assessment and management education program involving over 400 clinical staff (the entire hospice organization) to ensure that clinicians could appropriately respond to problematic pain scenarios. Finally, we will describe methods used to implement systematic reporting of pain assessment scores in a "real-time" basis enabling immediate responses to poorly controlled pain. At baseline measurement, we found that 42% of all patients admitted to hospice care had a pain score of >= 5/10; 68% of these patients had relief of their pain to mild or less (<=4/10) within 72 hours of start of hospice care. We will describe the structure and process changes (education, documentation, and technology interventions) that were put in place over the subsequent 24 months that led to a significant improvement in pain outcomes. At the conclusion of this phase of the project, pain is now relieved to mild or less in 94.6% of all patients within 48 hours of start of hospice care.

Funding: None