Incorporating patient preference into as needed pain orders at a large academic health system

Background

Joint Commission Accreditation Surveys at multiple hospitals within the Yale New Haven Health System (YNHHS) revealed that patients often requested lower doses and/or lower potencies of as needed (PRN) pain medications than those ordered for their reported pain score. This resulted in the potential for PRN pain medications to be given without a proper order or risking a delay in care while waiting for a new medication order to be placed by a clinician. This project followed the requirements set forth by The Joint Commission to seamlessly integrate patient preferences into the health system electronic health record (EHR) to enhance patient care and reduce unnecessary opioid consumption.

Methods

Two Joint Commission Standards that provided project guidance were PC.01.02.07 (the hospital manages and assesses patient pain while minimizing risks) and MM.04.01.01 (medication orders are clear and accurate). Implementing the proposal involved modifying the existing PRN pain orders and the Medication Administration Record (MAR) and updating the YNHHS Pain Assessment and Management policy. Education was developed and shared with clinicians, nursing, and pharmacy, along with a Tips and Tricks document for this newly developed workflow.

Results

The project successfully enhanced utilization of as needed pain medication orders through incorporation of patient preference options into PRN pain medication orders. Feedback after implementation from clinicians and nursing staff was also positive.

Conclusions

This project successfully demonstrates how large academic health systems can incorporate patient preference into PRN pain orders.