PCSS-ASPMN Dieterichs Lutz Mar2019 V3 FINAL For HANDOUTS

3/27/2019Reducing Inpatient Opioid ConsumptionCreating a Therapeutic Foundation with Breakthrough Analgesia Basedon Patient FunctionChad Dieterichs, MDPeggy Lutz, FNP-BC, RN-BCMarch 27, 20191Conflict of Interest Chad Dieterichs, no conflict of interest Peggy Lutz, no conflict of interest2Educational ObjectivesAt the conclusion of this activity, participants should be able to:1. Identify the fundamental concepts of person-centered, multi-modalpain management.2. Describe the components included in development of therapeuticactivity goals.3. Discuss the step approach to pain management based on patientfunction.31

3/27/2019About AscensionAscension is a faith-basedhealthcare organization that deliverspersonalized, compassionate careto all, especially to those whoare poor and vulnerable.Ascension is the largest Catholichealthcare organization in thecountry, with over 156,000associates and 34,000 alignedproviders working as one to connectcare and deliver solutions toindividuals and communities in 21states and the District of Columbia. In FY18, Ascension provided nearly 2billion for care of persons living inpoverty and community benefit. Our Mission-driven work is carried outthrough a number of subsidiariesdedicated to providing healthcareservices to support personalized,compassionate care.4USAP’s mission is to provide superior anesthesia services through our commitmentto quality, excellence, safety, innovation and leadership. USAP recognizes the valueof all people and is devoted to achieving positive outcomes via relationshipsestablished between patients, employees and clinical staff. 3500 clinical team members 26 million people served Locations in 8 statesManaging Pain in a Time of Opioid Crisis62

3/27/2019Guidelines, Guidelines, and MORE Guidelines7Our Pain Management Journey8Pain Management andOpioid Stewardship Initiatives93

3/27/2019From dosing to numbers Pain management order sets were not reflective of currentevidence-based pain management practice PRN medication orders based on pain intensity score, which mayover or undertreat a patient’s pain Minimal use of scheduled non-opioid foundation Citations by The Joint Commission regarding therapeuticduplication, nurses practicing out of scope, etc. Inconsistent use of integrative therapies10 to use of a multimodal pain management plan Scheduled “non-opioid” foundation Defined interdisciplinary Therapeutic Activity Goal (TAG)to drive the plan of care for the physician, patient, andcare team PRN analgesic dosing connected to patient’s ability toachieve TAG Increased use of integrative/complementary therapies11Therapeutic Activity GoalDefinition The level of acceptable pain intensity, the level and types of desired activities,and the ability to accomplish other patient-centered functional goals.Key Points Partnership between the multidisciplinary team and the patient/family toestablish TAG Considers baseline level of function, mobility, ADLs, psychosocial elements(sleep/rest), treatment plan Evolves throughout the patient’s hospitalization based on their progress Continued assessment of pain scores as a component of TAG124

3/27/2019Establishing Therapeutic Activity Goals Make goal(s) specific and measurable Make goal(s) realistic Make goals relevant to thepatient's overall treatment goals Identify barriers that might interferewith ability to achieve goals and how thepatient and care team will address them Review TAG during dailymultidisciplinary roundsThis Photo by Unknown Author is licensed under CC BY-NC-ND13Therapeutic Activity Goals145

3/27/2019Patient Involvement: Key to Success Validate TAG and acceptable level of pain at the start of each shiftand PRN Patient education tips:“While it is generally not possible to take away all of your pain, we will doeverything possible to manage your pain effectively so you will re

Chad Dieterichs, MD Peggy Lutz, FNP-BC, RN-BC March 27, 2019 2 Conflict of Interest Chad Dieterichs, no conflict of interest Peggy Lutz, no conflict of interest 3 Educational Objectives At the conclusion of this activity, participants should be able to: 1. Identify the fundamental con