Background: • Northwell Health Hospital Medicine, based on published national guidelines and expert opinion developed an internal guideline for the inpatient management of the medical patient with acute pain combined with a corresponding order set to implement the recommendations. • Given spotty utilization of multi-modal analgesia and the risks of opioid use and misuse, we recognized an opportunity to reduce variation in acute pain care across our organization.
Purpose: • An infrastructure was developed to design and disseminate the pain medicine guideline and order set amongst the Hospital Medicine teams with continuous education on how to access/utilize the pain medicine guideline and order set.
Description: • The objective of the pain guideline is to consistently deliver up-to-date, guideline based, quality care without unnecessary variation across all hospital sites to ensure equity along with the highest care standards. • The inpatient pain order set serves as a tool to treat acute pain, in an opioid naive hospitalized patient, in a user-centric order sets to support ease of adherence to the guideline.
Conclusions: • We monitored for changes in order set utilization across Northwell Hospital Medicine programs from all of 2022 to the first nine months of 2023. During the 12-month period in 2022, order set utilization was 1,385. The order set utilization for all Hospital Medicine programs for January to October 2023 was 3,218, a meaningful increase from the year prior (see image 1.)• To increase order set and guideline utilization across the system, user centric design of the guideline and order set is not enough to ensure uptake. it is imperative to routinely and consistently provide education on its existence and method of use.• Developing an Acute Pain Management dashboard, focused on order set utilization, adherence to guideline-based treatments such as multi-modal analgesia, minimization of sedative-hypnotic co-prescribing, and variation in other identified best practices as process and outcome metrics. This will support targeted ongoing education to continually improve appropriate adherence to guidelines.
