WEB
Advancing the Safety of Acute Pain Management. Boston, Massachusetts: Institute for Healthcare Improvement; 2019. (http://Availableonihi.org)
This comprehensive report describes the recommendations of an expert panel convened by the Institute for Healthcare Improvement to examine acute pain management. The 68-page document is a free download on http://ihi.org. Joan Maxwell and John Kruger, MD, MPH, served as cochairs of this project. An expert panel contributed to the final recommendations, and Diane W. Shannon, MD, MPH, served as lead author for the final document. This group specifically and uniquely addressed acute pain management as a patient safety issue.
The report addresses a comprehensive approach as the executive summary states, "truly advancing the safety of acute pain management will require a two-part paradigm shift. First, rather than focusing narrowly on reducing the use of opioids, clinicians and leaders can focus on a broader aim: providing comfortable, safe care for patients with acute pain."
Although prescriptions for opioids are on the decline, many questions remain. The report addresses systems issues about how to safely and effectively treat acute pain without overreliance on these drugs and provides guidance to prevent the overuse of opioids for acute pain. The report begins by describing 4 elements that must be in place to develop a plan:
* a common vision of acute pain management as a patient safety priority;
* comprehensive education, training, and evaluation of effectiveness of training;
* patient- and family-centered acute pain assessment, management, and monitoring; and
* effective systems of care.
The purpose of this report guide health care safety leaders to achieve specific goals, such as
* empower their role in advancing safe acute pain management practices in their organizations,
* elevate acute pain management as a key safety priority in their organizations,
* effectively serve as a bridge for consistent best practice across their organizations,
* design and implement pain management safety standards and programs,
* identify and apply relevant innovations in organization-wide approaches to acute pain management,
* measure and evaluate the effectiveness of interventions for managing acute pain, and
* sustain gains through continuous improvement activities.
Sections of the report include Acute Pain Management: A Critical Patient Safety Issue, Acute Pain Management: Where We Are and Where We Strive to Be, Acute Pain Management: Aiming for Safe Optimal Care, The Journey Toward Safe Acute Pain Management, and Action Steps for Health Care Safety Leaders. The report concludes that it is a starting point and a journey with an emphasis on improvement science. It includes steps that encourage leadership teams to build clinical teams and systems to develop a new model of care. The final sections provide references, tools and resources, and a case study. The case study describes how an organization may use the tools and resources in the document to develop and implement a safe acute care pain management strategy.
Tools within the document encourage leaders to complete a cultural assessment, discuss roles and resources, and identify factors that may impede the process. A worksheet guides leaders through an information technology assessment, and a driver diagram (a common tool of improvement science) provides a blueprint for a model program, including time frames, measures, and outcomes, while targeting change ideas that must be tested. One checklist even directs presurgery conversations between patients and surgeons or nursing staff.
This guide is a comprehensive tool for all organizations and leadership teams. It is timely, as all providers are working to address and resolve the complications of opioid misuse, overuse, addiction, and pain management through a new and informed lens. A free PDF download is available at http://IHI.org and may require log-in/registration.
A short companion video entitled "Advancing the Safety of Acute Pain Management" is also available on the Institute for Healthcare Improvement site and on YouTube (https://youtu.be/2mHiVsL1YkY).
The 3.41-minute media clip may be used to introduce the report or as a stand-alone education tool. The clip provides commentary from expert panel members and patients, as they discuss opportunities to improve communication throughout all health care environments as they take a broad view to address the safe and effective use of opioids.