The Society of Hospital Medicine (SHM) has developed a guide, Improving Pain Management for Hospitalized Medical Patients, offering suggestions and best practices. The focus of the Guide is toward implementing and sustaining a pain management quality improvement program and how facilities can improve their policies and procedures to assist providers in combatting opioid addiction and abuse.
This report responds to the committee’s charge by providing a blueprint for transforming the way pain is understood, assessed, treated, and prevented. It provides recommendations for improving the care of people who experience pain, the training of clinicians who treat them, and the collection of data on pain in the United States.
Competence and Quality Care
Healthcare System and Hospital Setting
The Optimal Pain Management program’s goal is to create a systematic practical approach that will lead to a “turn key solution” to evaluate, prevent and manage pain. (Safe, Timely, Effective, Efficient Equitable and Patient-centered) The Pain Management program is one of the pillars to address the challenges of Opioid use in general and the role that legitimate medical care contributes to Opioid Use Disorder.
Additionally, the program will provide knowledge and tools to facilitate the health professionals working together in a continuous quality improvement process to find a collaborative method to reduce the occurrence, severity, duration, and devastating outcomes of acute and chronic pain.
To develop the tools and strategies to incorporate best practice of pain management into the clinical environment.
The MHS Pain strategy incorporates the Stepped Care Model of Pain Management developed by the Veterans Health Administration. The Stepped Care Model provides a roadmap to providing appropriate level and intensity of pain management and effective treatment to patients with acute and chronic pain. This video provides an explanation of the Stepped Care Model for Pain Management and its use in the DoD and VHA.
A systems approach and framework to design interventions to improve pain management needs to be multilevel as the interventions address the behaviors of providers, patients and the healthcare organization.
Patient bill of rights
Patient and family education
Debriefing of care episode
Step 1: Form an Interdisciplinary Team with a Common Goal
The first step in initiating a program to improve pain management at a hospital or within a service line or unit is to form an interdisciplinary team to lead the project. Interdisciplinary pain care results in better health processes and outcomes for both acute and chronic pain.
Once a team has been assembled, the initial vision of the project can be fleshed out. Stakeholders and team members will likely have a number of different needs and perspectives on how to improve pain management.
Step 2: Obtain Institutional Support
As with any quality improvement project, obtaining institutional support for any pain management improvement project is necessary for success. Obtaining support from institutional leaders is critical because there are many competing strategic priorities in healthcare organizations, and pain management requires organizational resources and interdisciplinary leadership.
Step 3: Assess the Current State of Pain Management in Your Facility
Before an intervention is finalized and launched, a formal assessment of the current state of pain management at your facility should be conducted. This assessment should inform the intervention to be deployed to make sure it addresses the key areas of need and utilizes the resources available to you.
Step 4: Institutional Best Practices for Hospital Pain Management
The following sections provide an overview of best practices in pain management at the institutional level. This overview is not intended to be a comprehensive guide to pain management of the individual, since many textbooks and guidelines are already available for this purpose.
Step 5: Choose Metrics and Develop a Data Collection Plan
Metrics for a pain management quality improvement project are based on the project’s scope and aims. Although interest is high on outcomes, a tunnel-vision approach that focuses only on the end result will miss what can happen in the intermediary steps if the end outcomes are not achieved. Thus, metrics should include structure, process and outcomes related to the specific aims of quality improvement goals.
Step 6: Deploy Interventions and Monitor Impacts
Efforts to improve pain management should focus on improved patient care including assessment, treatment efficacy and safety, as well as organizational structures and processes. The focus should be on increased patient engagement in the treatment plan and implementation of evidence-based treatment regimens customized to the circumstances.
Step 7: Improving Transitions of Care for Patients with Pain
Transitions are vulnerable times for all patients, and this is even more true for patients with pain and/or complicated pain management regimens. Patients frequently face challenges in getting prescriptions filled after discharge, or confusion about how to take their medications.