Administrative Memos

199907

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jun 16, 1999
SUBJECT: Postoperative Pain Management in New York State - An Impact Report
IPRO CONTACTS:

Terri Straub, R.N., M.B.A., Senior Director, Improvement Strategies/QI - Ext. 410 and Marguerite Shaffer, R.N., Director, QIP/Downstate - Ext. 356

Enclosed is a copy of IPRO's report Postoperative Pain Management in New York State - An Impact Report. This report describes various improvements in the quality of care that postoperative patients are receiving following interventional efforts by IPRO and a group of voluntarily collaborating hospitals in New York State. Numerous quality improvement plans were implemented and included such strategies as providing education for physicians and other clinicians; developing and distributing patient educational materials; improving in-house staff training to include the AHCPR Guideline for the management of postoperative pain; and revising postoperative clinical pathways to include better assessment, documentation, and management of pain.

Among the improvements noted in this project were the following:

The frequency of general preoperative discussions of pain management increased from 65% to 78%.
The frequency of preoperative discussions regarding options of pain control increased from 8% to 27%.
The frequency of preoperative discussions about standardized pain assessment tools increased from 24% to 56%.
The utilization of a postoperative pain tool on the day of surgery increased by 13% and the utilization of such a pain tool on the first postoperative day increased by 11%.
The use of continuous baseline pain medication strategies increased from 72% to 77%.
This study should be of special interest to anesthesiologists, surgeons, internists, specialists in pain management, nursing directors, PACU coordinators, pharmacists, as well as quality improvement professionals and hospital administrators.

IPRO urges all hospitals in New York State to be aware of the AHCPR recommendations, to encourage increased Medicare beneficiary awareness of the various alternatives available for pain management, to encourage staff to utilize standardized pain assessment tools, and to support the use of the most effective pharmacologic and non-pharmacologic interventions.

Should you have any questions about IPRO's "Postoperative Pain Management in New York State - An Impact Report" project or report, please feel free to contact Dr. Charles Stimler, Marguerite Shaffer, or Terri Straub.

EXECUTIVE SUMMARY

In New York State over 1.3 million operations are performed annually, and most of these involve some form of postoperative pain management. Surveys have shown that sub-optimal pain management and unrelieved pain commonly occur among surgical patients, despite the availability of effective pain assessment tools and effective strategies for minimizing postoperative pain. Contributing factors to this situation include both health care provider and patient misconceptions. The process of postoperative pain management can be improved by implementing the recommendations of the Agency for Health Care Policy and Research (AHCPR). These include: the introduction of expertly provided preoperative patient education, regular formal pain assessment with a standardized pain assessment tool, maintenance of a continuous baseline blood level of pain medication, avoidance of frontline meperidine use, and the inclusion of non-pharmacologic techniques of pain control.

IPRO conducted a quality improvement effort based on the 1992 AHCPR Guideline recommendations for postoperative pain management and this report details the outcome of this effort. Both baseline and impact samples were collected from over 40 hospitals which voluntary collaborated with IPRO on this project. The baseline period was between July, 1995 and June, 1996 and the impact period was between January and April, 1998. Between these two periods, the collaborating hospitals partnered with IPRO to develop quality improvement plans and to institute changes in the processes-of-care related to postoperative pain management. The impact outcomes documented the following improvements which were statistically significant:

The frequency of general preoperative discussions of pain management increased from 65% to 78%.
The frequency of preoperative discussions regarding options of pain control increased from 8% to 27%.
The frequency of preoperative discussions about standardized pain assessment tools increased from 24% to 56%.
The utilization of a postoperative pain tool on the day of surgery increased by 13% and the utilization of such a pain tool on the first postoperative day increased by 11%.

These outcomes suggest that significant improvements can result from a cooperative statewide quality improvement effort. Despite these encouraging results, there is a need for greater effort in improving the performance of postoperative assessments, decreasing frontline use of meperidine, and integrating non-pharmacologic therapies together with drug therapies.