EP4EO

 

Care Delivery System EP4EO

 

1. Provide one example, with supporting evidence, of an improvement in a patient outcome associated with one (internal or external) expert or multiple (internal or external) experts’ recommended change in nursing practice.
2. Patient outcome data must be submitted in the form of a graph and table

 

 

Example: Improvement in Patients’ Control of Pain

Problem
In light of the current opioid epidemic, the Yale New Haven Health System has been looking for ways to minimize the use of opioids during patients’ hospital stays and to minimize the number of opioid prescriptions given upon discharge. While there are several ongoing initiatives to modify order sets and improve staff education on opioid use, there was no patient education tool readily available to use at the patient’s bedside. 

 

The Greenwich Hospital Surgery Unit nursing staff was surveyed in June 2018, with only 76% of them reporting being confident in providing both pharmacological and non-pharmacological relief for patients’ pain.

 

In addition, patient satisfaction scores on the Surgery Unit demonstrated an opportunity to improve the management of patients’ pain during their hospital stay.

 

In June 2018, the patient satisfaction scores on Surgical Unit for the question “How well was your pain controlled?” was 89.1%. This is measured as the percent of response ‘always”. 

 

Goal Statement
Improve the Surgery Unit patient satisfaction score for the question, “How well was your pain controlled?”

 

Participants

 

Comfort Menu Steering Committee
Name/Credentials	Discipline	Title/Role	Department
Ann Nardi, DPT, PT, Internal Expert	Physical Therapy	Coordinator of the Total Joint Replacement and Spinal Fusion Programs, Internal Expert	Surgery
Jessie Riemer, MSN, RN, CPHQ	Nursing	Accreditation and Regulatory Specialist	Performance Management
Peggy Lennon, MSN, RN, NE-BC	Nursing	Program Director	Surgical Services
Carol Ann Doherty, BSN, RN, Internal Expert	Nursing	Clinical Coordinator, Internal Expert	Surgery
Roberta Brown, BSN, RN, CHTP/I, Internal Expert	Nursing	Integrative Medicine Coordinator, Internal Expert	Integrative Medicine
Sheila Finn, MSN, RN, Internal Expert	Nursing	Clinical Coordinator, Clinical Resource Nurse, Internal Expert	Surgery
Debi D’Alba	Administration	Director, Patient and Guest Relations	Patient and Guest Relations
Julie Wahnish, DPT, PT	Physical Therapist	Inpatient Physical Therapy Coordinator	Physical Medicine
Susanne Vella, BSN, RN, Internal Expert	Nursing	Clinical Nurse, Internal Expert	Surgery
Kasey Connor, BSN, RN, Internal Expert	Nursing	Clinical Resource Nurse, Clinical nurse, Internal Expert	Surgery
Marisa Weinberger, BSN, RN, Internal Expert	Nursing	Clinical Resource Nurse, Clinical nurse, Internal Expert	Surgery
Kat Ogden, MSN, RN, Internal Expert	Nursing	Clinical Resource Nurse, Clinical Nurse, Internal Expert	Surgery
Sarah Delinski, BSN, RN, Internal Expert	Nursing	Clinical Nurse, Internal Expert	Surgery

 

Description of the Intervention

 

July 2018-December 2018

Internal experts were identified to lead the project. Ann Nardi, DPT, PT, Physical Therapist and Coordinator of the Total Joint Replacement and Spinal Fusion Programs, has been practicing physical therapy for over 12 years. As a physical therapist, she is an expert in non-pharmacological pain management techniques, specifically, using movement or positional changes to improve comfort. Roberta Brown, BSN, RN, CHTP/I, registered nurse and Coordinator of Integrative Medicine, is an expert in using complementary therapies for pain management. She has been a nurse for 42 years and is a certified Healing Touch practitioner and instructor. 

 

Nardi and Brown combined their expertise to develop alternative ways for nurses to manage patients’ pain. Nardi identified key stakeholders in proper pain management for surgical patients, including bedside nurses/leaders, nursing management and physical therapists. Debi D’Alba, Director of Patient and Guest Relations, was included to provide expertise in the patient experience. Additional clinical nurse internal experts are Carol Ann Doherty, BSN, RN, Sheila Finn, MSN, RN, Kat Ogden, MSN, RN; Suzanne Vella, BSN, RN; Marisa Weinberger, BSN, RN; Sarah Delinski, BSN, RN; and Kasey Connor, BSN, RN, who have five to 15 years of experience caring for surgical patients, hold orthopedic certifications and have taken additional education classes in the care of surgical patients.

 

To highlight non-pharmacological options for pain management techniques, the multidisciplinary steering committee, with recommendations from internal experts Nardi, Brown and D’Alba, created The Comfort Menu with feedback from the Patient and Family Advisory Council and Hospital Leadership. The Menu provides ways that nurses and ancillary staff members can assist in pain management, including Comfort Actions, Comfort Items, Relaxation Techniques, Distraction Techniques and Medications for Comfort. Nardi and other members of the committee educated the Surgery Unit nursing staff on the use of the Menu, and it was piloted on the inpatient Surgery Unit.

 

All interventions were fully implemented by the end of December 2018.

 

Outcomes
The contributions of internal experts Nardi and Brown resulted in an improvement in the Press Ganey scores regarding pain management post-intervention in January, February, and March 2019, to 93%, 91% and 95%, respectively. The use of opiods also decreased, with the total MME (morphine milligram equivalents) per patient stay decreasing from 131 MME in June 2018 to 118 MME in January 2019. The average MME prescription upon discharge also decreased, from 284 MME in June 2018 to 212 MME in January 2019.  

 

 

Evidence EP4EO-1, Greenwich Hospital Surgery Unit Patient Satisfaction: How Well Your Pain Was Controlled