The checklists: A help or a hassle?

Improving acute pain management of trauma patients on medication-assisted therapy

BACKGROUND

Approximately 9,500,000 people in the United States misused opioids in 2020. Many people manage their opioid use disorder (OUD) with medication-assisted treatment (MAT). Using MAT to address OUD adds to the complexities and challenges of adequate acute pain control.

LOCAL PROBLEM

Chart review indicated only 20% of trauma patients on MAT achieved adequate pain control on the trauma service at the University of Louisville Hospital. This quality initiative aimed to increase patient pain control to 50% in 90 days.

METHODS

A rapid cycle quality improvement project with four plan-do-study-act (PDSA) cycles was conducted over 8 weeks. Four core interventions were implemented concurrently, with tests of change biweekly. Qualitative and qualitative data analyses were completed at each cycle.

INTERVENTIONS

The core interventions included a risk assessment tool, shared decision-making (SDM) tool, provider checklist, and a team engagement plan.

RESULTS

The number of patients with a pain score of ≤5 (scale 0-10) increased to 78% from 20%. The mean pain score decreased from 8 to 4.6. The fourth PDSA cycle results showed a 92% patient engagement with SDM and 100% utilization of the provider checklist. Team engagement scores greater than 4 on a 5-point Likert scale were 86%.

CONCLUSIONS

Effective patient-centered acute pain control for trauma patients on MAT is achievable. The combined use of an SDM tool and a provider checklist was an efficient way to provide effective and patient-centered care and positively affected patient outcomes.